Billing Specialist II - PB

Phelps Health; United States; On-site; USD 42,000 - 64,000; Full time

Job summary

Phelps Health is a 2000-employee hospital serving central Missouri. The Billing Specialist II role focuses on entering and submitting claims, posting insurance, and answering patient questions about accounts.

You will work under the Billing Supervisor to resolve claim issues, verify benefits, and manage denials. A related degree or billing certification plus 3 years of billing experience is required.

Qualifications

• Associate degree in health care or related field, or billing certification.
• 3 years medical billing experience required; high school diploma acceptable with experience.
• Experience with billing software and payer portals preferred.

Responsibilities

• Enter information necessary for insurance claims such as patient insurance and insurance ID.
• Submit insurance claims to clearinghouse or insurance companies electronically or on paper forms.
• Answer patient questions regarding insurance claims processing and coverage/payments.
• Follow up on unpaid or rejected claims and resubmit; forward denials for appeal when needed.
• Prepare appeal letters and collect information to accompany letters.
• Verify patient benefits eligibility and coverage using payer portals or by contacting payers.
• Research reference material to ensure claims are submitted clean on first pass and follow up as needed.
• Ensure correct occurrence and condition codes on claims; refer coding issues to appropriate staff.
• Submit replacement claims when late charges occur.
• Collaborate with precert team on authorization issues.

Skills

Medical billing

Claims processing

Customer inquiries

Education

Associate Degree in healthcare or related field

Billing certification

High School diploma or GED

Tools

Billing software

Electronic data submission

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.

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General Summary

• The Billing Specialist II 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 is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Be a secondary resource to answer patient questions regarding insurance claims processing and insurance coverage/payment issues, which may include explanation of patient portion amounts such as, copays, deductibles, and contractual adjustments.
• Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims. If not able to resolve the issues, forwards the denial to DPR to review for appeal.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Recognize managed care contract terms and reimbursement methodologies. Resolve under/over payment disputes with payers based upon contracted terms and reimbursement amounts received.
• Verify patient benefits eligibility and coverage, using the payer portal or contacting the payer directly, as needed.
• Ability to research and use electronic (websites or payer portals) or paper reference material to ensure that claims are submitted clean and on first pass to the payer. Also uses this reference material when following-up claims that need timely review.
• Insures the appropriate occurrence and condition codes have been applied to the claim.
• Refers coding issues to the appropriate coding staff.
• Submits replacement claims when late chares occur.
• Works with precert team with issues related to authorization issues.

Education

• Associate Degree in health care or other related field or certified in billing by an accredited organization required. Will consider years of medical billing experience in lieu of this requirement. High School diploma or GED required.

Work Experience

• 3 years medical billing experience required. Experience in billing software and electronic data submission preferred.

Certification/License

• Not required.

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.

Phelps Health

Phelps Health is a leading regional healthcare provider dedicated to integrity, compassion, and innovation, offering diverse career opportunities in clinical and non-clinical roles.

Hospitals and Health Care

Company size 1,001–5,000 employees

Company type Nonprofit Founded 1951

Total funding 0

Momentum

Team growth

Momentum

Team growth

10% in 12 mo

769 employees on LinkedIn

Jan 23 May 26

Employee experience

What it’s like inside

3.2

123 reviews

65% would recommend

Culture & values

Culture & values 3.2

Work-life balance

Work-life balance 3.6

Career opportunities

Career opportunities 3.1

Compensation & benefits 3.1

Capital

Funding history

Footprint

Where they work