Billing Specialist I - PB

LE01 Phelps County Regional Medical Center; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

Phelps Health seeking a Billing Specialist I to manage insurance claim processing, data entry, and patient inquiries in a hospital setting. You will submit claims, verify benefits, and assist with denials and appeals while maintaining HIPAA standards and offering support where needed.

The role involves communicating with patients and insurers, following up on unpaid claims, and coordinating with the billing team to ensure accurate account resolution.

Qualifications

• High School Diploma or GED required.
• Medical billing experience highly preferred.
• Experience in billing software and electronic data submission preferred.

Responsibilities

• Enter information necessary for insurance claims (patient, insurance, Insurance ID).
• Submit insurance claims to clearinghouse or insurers electronically or on paper forms.
• Answer patient questions on balances, copays, and deductions; resolve concerns or explain coverage.
• Follow up with insurers on unpaid or rejected claims and re-submit as needed.
• Prepare appeal letters when claims are denied and assemble supporting information.
• Maintain HIPAA compliance in handling patient information.
• May perform soft collections for past-due accounts as needed.
• Verify patient benefits eligibility and coverage; process secondary claims after primary processing.

Skills

Medical billing experience

Education

High School Diploma or GED

Tools

Billing software

Job description

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.

General Summary

The Billing Specialist I is responsible for collecting and entering claims, post insurance, submit claims, and answer patient inquiries on accounts. Reports to the Billing Supervisor.

Essential Duties and Responsibilities

• Enters information necessary for insurance claims such as patient, insurance, and insurance ID.
• Insures claim information in complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc. resolves patient's complaints or explains why certain services are not covered.
• Follow up with insurance company on unpaid or rejected claims.
• Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Follows HIPAA guidelines in handling patient information.
• May perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Understand managed care authorizations and limits to coverage such as number of visits.
• Verify patient benefits eligibility and coverage as needed.
• Prepares and submits secondary claims upon processing by primary insurer.

Standards of Behavior

• Integrity: I believe in being personally accountable for doing what is always right.
• Compassion: I believe in acting on the empathy felt toward the needs of patients and families.
• Innovation: I believe in being inspired to provide care in new and creative ways.
• Philanthropy: I believe in being a good steward of the gift of time, deeds and resources for our patients and community.

Job Qualifications

• Education High School Diploma or GED required.
• Work Experience Medical billing experience highly preferred.
• Experience in billing software and electronic data submission preferred.

Certification/License

N/A

Mental/Physical Requirements

Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds.

Working Conditions

Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.

At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself!

Phelps Health serves over 200,000 residents in south-central Missouri. Phelps Health is county-owned, non-tax supported and is overseen by a five-member elected board. Phelps Health employs more than 1,900 people, including 100-plus providers. Phelps Health, which includes a hospital licensed for 240 patient beds, serves a six-county area, with its main campus and several clinics located in Rolla, Missouri. Phelps Health also has clinics in Salem, St. James, Vienna and Waynesville, Missouri.