Insurance Billing Specialist

Box-Butte-General-Hospital; Alliance (NE); On-site; USD 35,000 - 52,000; Full time

Job summary

Box Butte GeneralHospital in Alliance, Nebraska, is seeking an Insurance Follow-Up/Payment Specialist to manage Medicare, Medicaid, commercial, MVA, and Workmen's Comp claims with limited supervision. You will work with the Patient Financial Services team to verify coverage, follow up on denials, process payments, and document activities in Meditech, while maintaining positive patient relations.

The role requires data entry accuracy, good telephone communication, and the ability to coordinate

Qualifications

• High school diploma or equivalent required.
• CPAT certification preferred.
• Experience with telephone interactions and data entry skills.
• Experience in billing/collections is a plus.

Responsibilities

• Follow up on Medicare, Medicaid, commercial, MVA, 3rd party liability and Workmen's comp claims.
• Process payments for insured accounts with data entry in Meditech.
• Submit secondary payer claims and track denials.
• Document all interactions and payments in Meditech.
• Coordinate with hospital departments for pre-certification and authorization requirements.
• Participate in staff meetings and ongoing education.

Skills

Telephone etiquette

Data entry

Customer service

Billing/collections

Education

High school diploma or equivalent

CPAT Certification

Tools

Meditech

UB04 form processing

Job description

Title: Insurance Follow-Up/Payment Specialist

Reporting Relationship: Patient Financial Services Manager
General Summary of Responsibilities: With limited supervision, the insurance follow-up clerk is responsible for follow-up of Medicare, Medicaid, commercial insurance, MVA, 3 rd Party Liability, and Workmen's Comp claims. Effectively communicates with insurance billing specialist to ensure claims are followed up on in a timely manner. Effectively communicates via telephone with insurance customer service representatives. Uses the internet to navigate insurance company websites to check on claim status. Builds a positive relationship with patients inquiring about claim status and payment. With limited supervision, process payments from Medicare, Medicaid, commercial insurance companies, workmen's comp, 3 rd party liability and motor vehicle accident insurance companies on a daily basis for data entry. Cross train with other positions to ensure a smooth workflow. Together with team members, communicate in a manner that builds positive patient relations. Participates in monthly staff meetings and attends classes, workshops, seminars relating to billing/collections of accounts.

To verify insurance coverage, pre-certification and/or pre-authorization requirements for Inpatient, Outpatient Observation and outpatient services patients. To coordinate activities with the Utilization Review, Surgery and other departments to assure pre-certification requirements are met. All communications are conducted in a manner that will result in positive patient relations.
Essential Job Responsibilities:

Insurance Follow-Up Specialist:

Submit secondary payer claims to appropriate insurance following up every 60 days or more often as necessary to track payments or problems.

Submit secondary payer claims within 5 days of receiving primary insurance explanation of benefits.

Follow through on Medicare, Medicaid, commercial insurance, VA, MVA, 3rd Party Liability, and Workmen’s comp claims identified as requiring action as a result of denials and/or no payment claims.

Create UB04 using Meditech system if needed to resubmit a claim followed up on.

Maintains Medicare, Medicaid, commercial insurance, VA, MVA, 3rd Party Liability, and Workmen’s Comp claims, 90 days and older at or below 15% of total claims outstanding.

Documents all follow up to claims in Meditech system.

Handles phone, mail, and personal inquiries from patients promptly, efficiently, and courteously.

Follows through on all issues identified requiring action as a result of inquiry.

Documents all phone and personal inquiries in Meditech system.

Manage Professional accounts including billing claims and following up in order to receive payment.

Participates in educational opportunities offered by the hospital for job and personal development.

Participates in monthly staff meetings and attends classes, workshops, seminars relating to billing/collections of accounts.

Other duties as assigned.

Payment Specialist:

Process Medicare, Medicaid, commercial insurance, workmen’s comp, 3rd party liability, and motor vehicle accident insurance payments for data entry.

Analyze Explanation of Benefits and make notation of whether account should be rolled to secondary payer.

Assign proper payment type on claims when no payment is being made and follow up with the appropriate insurance company.

Verify that admissions are in the correct financial class based upon which insurance company is making the payment.

Fill out cash receipt form for data processing to balance payments.

Documents detailed payment information in current computer system to clearly explain and easily track payment history.

Reconcile Medicare, Medicaid, commercial insurance, workmen’s comp, 3rd party liability, and motor vehicle accident insurance contractual payments, daily deposits, and contractual cash receipts journal.

Scan and upload all insurance remittance advices to Meditech with the correct date and ensure all remittance advice is readable.

Assist in maintaining Medicare, Medicaid, and Commercial insurance claims including workmen’s comp, 3rd party liability, and motor vehicle insurance, 90 days and older at or below 15% of total claims outstanding.

Coordinates activities with hospital departments to assist in meeting pre-certification or pre-authorization requirements for inpatients, 23 hour observation and surgery patients.

Communicates with the Outpatient Surgery and the Multi-Specialty Clinic departments to access schedules and assist in meeting insurance pre-certification requirements for patients on the surgery schedule.

Coordinate activities with Utilization Review staff to verify insurance eligibility and coordinate activities related to pre-certification requirements of Inpatients and 23-hour observation of patients.

Contact a patient’s insurance company to verify coverage & benefits for inpatients, observation patients and surgery patients.

Contact the patient or his/her representative by phone to gather demographic and insurance information prior to the surgery date.

Contact insurance companies via internet and/or phone to verify insurance eligibility and document coverage and benefits.

Access the Medicare Common Working File to verify Medicare coverage, eligibility dates and other insurance coverage.

Enters patient demographic and insurance information in the Meditech system efficiently and accurately.

Document information relating to insurance eligibility, pre-certification and/or pre-authorization information or confirmation numbers.

Follows up on insurance non-payment claims relating to pre-cert or pre-authorization requirements.

Handles phone, mail and personal inquiries from and regarding patient accounts.

Assists each person promptly, efficiently and courteously.

Follow through on all issues identified as requiring action as a result of inquiry.

Document all phone and personal inquiries in the Meditech system.

Performs duties with a minimum of supervision, exhibits innovation and good judgment.

Other Job Functions:

Provides back-up for the PBX during vacancies and absences. Enhances professional development by taking steps to remain knowledgeable of industry standards, and attending meetings and seminars as assigned. Actively participate in BBGH Performance Improvement activities.. Attends a minimum of 80% of mandatory staff meetings. Contributes to the prevention of infectious disease among employees and patients by adhering to infection control policies and procedures.Contributes to adequate staffing of department by reporting to work at a scheduled time. Contributes to effective guest relations by assisting patients, visitors and physicians to resolve expressed concerns and demonstrating a welcoming and helpful attitude. Conserves hospital resources by using equipment and supplies as needed to perform job duties. Keeps information confidential by adhering to the terms of personnel policy concerning confidentiality. Maintains a clean and calm environment.Completes all required paperwork/computer entry for each patient needed. Follow the Standards of Behavior. Utilize TeamSTEPPS tools. Participate in Patient Experience.Regular attendance. Performs other related duties as assigned or requested.

Job Qualifications:

Age Requirement

Required: Must be 19 years or older

Education:

Required: High school diploma, or equivalent.

Experience:

Required: Computer Skills/Keyboarding

Preferred: Previous experience in use of the telephone to gather customer information.

License/Certification

Required:

Preferred: Certified Patient Accounts Technician (CPAT) Certification

Box Butte GeneralHospital is an Equal Opportunity Employer.

Post-offer/pre-employment background check and drug screen are required.