Experienced Insurance Billing Specialist

Joseph M. Still Burn Centers, Inc.; Augusta (GA); On-site; USD 42,000 - 56,000; Full time

Job summary

Joseph M. Still Burn Centers, Inc. is seeking an Insurance Billing Specialist to manage outstanding insurance accounts receivable, track denials, and submit complex appeals. The role requires expertise in physician billing and payer guidelines to help ensure timely reimbursement.

The ideal candidate will have at least two years of medical billing/coding experience, strong knowledge of CPT/ICD codes, and the ability to communicate with insurers and patients effectively.

Qualifications

• High school diploma or GED required.
• Two years related experience in medical billing and/or coding.
• Experience with payer guidelines and denial management preferred.

Responsibilities

• Manage patient account insurance balances.
• Denials and insurance follow up management.
• Appeals incorrectly paid or denied claims.
• Handle insurance inquiries and resolve issues.
• Post adjustments and transfer of responsibility to insurance and/or patient.
• Negotiate settlements and payment arrangements with carriers and patients.

Skills

Insurance billing

Medical coding

Accounts receivable

Education

High school diploma or GED

Job description

Description

The Burn and Reconstructive Centers of America (BRCA) is committed to following our mission that harkens back the first patient in 1978: Healing Patients. Healing Families. Healing Lives. Our mission is important to us because it’s important to those we serve.

Since the first patient was treated at Doctors Hospital in Augusta, Georgia, in 1978, our physicians banded together to first create Physicians’ Multispecialty Group to provide patient care. PMG evolved into Joseph M. Still Burn Centers, Inc. (JMS), the forerunner of BRCA. And now BRCA continues to grow and partner with hospitals across the country to provide patient access to a continuum of care that supports the patient from initial injury through long-term rehabilitation, while ensuring no patient is turned away. We provide quality burn, hand, wound and reconstructive care to patients through new facilities, new partnerships and the latest advancements in care.

Four decades later, BRCA is the nation’s most extensive burn system. Patients from nearly every state in America and more than a dozen countries have been treated by our providers. Headquartered in Augusta, GA, Burn and Reconstructive Centers of America provides services from the nation's largest individual burn center: the Joseph M. Still Burn Center at Doctors Hospital of Augusta.

Job Purpose:

The Insurance billing specialist position is responsible for managing outstanding insurance accounts receivable to optimize cash flow and secure timely reimbursement. This role focuses heavily on tracking denials, submitting complex appeals, to proactively reduce days in AR. The ideal candidate possesses deep expertise in physician billing, commercial and government payer guidelines, and root-cause analysis.

Essential Duties and Responsibilities:

• Manage patient account insurance balances.
• Denials and insurance follow up management.
• Appeals incorrectly paid or denied claims.
• Handle insurance inquiries.
• Post adjustments and transfer of responsibility to insurance and/or patient.
• Issue refunds after auditing accounts.
• Negotiates settlements and sets up payment arrangements with insurance carriers and patients.
• Works with credentialing department to ensure that all providers are credentialed and communicate and provider enrollment status.
• Monthly conference calls and/or site visits with insurance carrier representatives.
• Follow up on assigned accounts by a specific payer.
• Works with precertification department to obtain authorizations.
• Maintain working knowledge of regulations, guidelines, policies, and procedures for all insurance companies that pertain to physician and non-physician practitioners CPT codes.
• Keeping claims current to avoid untimely denials for appeals and corrected claims.
• Submit secondary claims w/ EOB
• Take patient billing calls and assist in any billing questions and/or payments.
• Maintain in close contact with insurance reps/adjusters, case managers regarding the issues we have with their perspective insurance company.
• Comply with all safety policies, practices and procedures. Report all unsafe activities to supervisor and/or Human Resources.
• Participate in proactive team efforts to achieve departmental and company goals.
• Perform other duties as assigned.
• Provide leadership to others through example and sharing of knowledge/skill.
• Participate in education sessions specific to corporate needs or job duties – locally or remotely, as needed.
• Provide training to other employees – locally or remotely, as needed.
• Maintain confidentiality of sensitive information.
• Participate in all mandatory training relating to applicable healthcare laws and regulations, and demonstrate full compliance with those regulations, including without limitation, HIPAA, OSHA, OIG, Federal, State and local laws and regulations.

Requirements

Education

High school diploma or general educationdegree (GED)

Experience

Two years related experience and/or training (Insurance billing and coding experience from previous medical billing office)

• We offer Medical/Dental/Vision/Life/401(k)/Vacation and Holidays.

Burn and Reconstructive Centers of America is an Equal Employment Opportunity Employer.