INSURANCE BILLING SPECIALIST, PATIENT FINANCIAL SERVICES

SGMC Health; Valdosta (GA); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health insurance

401(k) with employer match

Paid Time Off

Employee discounts

Life insurance

Disability insurance

Tuition reimbursement

Training and development

Job summary

SGMC Health seeks a Patient Financial Services Billing Specialist to process hospital claims, verify patient insurance coverage, and manage the end-to-end billing workflow. You will handle denials, follow up on unpaid balances, and ensure timely and accurate billing in a fast-paced environment.

The role requires familiarity with Epic HB Resolute, CPT-4/HCPCS/ICD-10 coding, and strong communication skills to interact with payers and internal teams.

Qualifications

• Prior hospital billing experience recommended.
• Submits claims in Epic HB Resolute Billing system.
• Documents and updates status of unpaid insurance balances.
• Verifies Medicare, Medicaid, and other 3rd Party eligibility.

Responsibilities

• Process incoming requests from departments to bill claims.
• Verify patient insurance coverage and benefits.
• Bill, correct edits, follow up unpaid balances and appeal denials.
• Review EOBs and communicate payer denial trends to supervisor.
• Maintain productivity and accuracy with volume targets.

Skills

Epic HB Resolute Billing

Insurance billing

CPT-4/HCPCS/ICD-10 familiarity

HIPAA knowledge

Communication skills

Data entry

Customer service

Payer denial analysis

Tools

Craneware

Microsoft Office

Experian claim portal

Job description

WHAT IT'S LIKE AT SGMC HEALTH

Description

WHAT IT'S LIKE AT SGMC HEALTH

Purpose

No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.

Excellence

We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.

Team Spirit.

We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.

Award Winning Performance.

We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.

WHY YOU WILL LOVE SGMC HEALTH

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

JOB LOCATION : SGMC Patient Financial Services

DEPARTMENT: PATIENT FINANCIAL SERVICES

SCHEDULE: Full Time, 8 HR Day Shift,

POSITION SUMMARY:

Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. Verifying patients’ insurance coverage. Answering billing questions from internal and external customers.Responsible for the timely billing, correction of edits, follow up of unpaid balances, and appealing of denials of hospital charges. Verifying patient’s insurance coverage and benefits. Answering billing questions from internal and external sources. Responsible for subset of payers and/or alpha split of payer groupings. Will be accountable for the overall health of the accounts receivables assigned. Responsible for daily review of correspondence, outstanding insurance credit balances, over-posted account balances, and paid claims with outstanding balances.

KNOWLEDGE, SKILLS & ABILITIES:

• Prior hospital billing experience recommended.
• Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system.
• Submits claims in Epic HB Resolute Billing system.
• Documents and updates status of unpaid insurance balances.
• Researches and analyzes various billing reference manuals to review billing accuracy.
• Documents electronic system regarding returned faxes and Certified Return Receipts. Completes production logs. Processes outgoing mail.
• Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems.
• Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, , Medicare, Medicaid, and other payer web portals, Craneware, Microsoft Office applications, and Experian claim source clearinghouse portal.
• Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach State; Wellcare; CareSource, Amerigroup; Tricare (Standard, Extra and Prime); VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.
• Working knowledge of CPT-4, HCPCS, and ICD-10.
• Knowledgeable of insurance and reimbursement process.
• Must have a thorough understanding and knowledge of: patient type; financial class; insurance master; place of service codes;; relationship codes; accommodation, occurrence, value and condition codes.
• Related regulatory and legal requirements: Medicare Secondary Payer Questions; medical necessity; Medical Reviews and Appeals.
• Interacts with: patients; other departments; insurance companies; employers; intermediaries; utilization review companies; state regulatory agencies (GMCF, Medicaid); and attorneys.
• Knowledge of medical terminology. Strong verbal/written communication skills, highly organized with the ability to prioritize work.
• Able to communicate effectively with a wide range of individuals. Substantive communication required with physicians, insurance companies, customers and staff. Must be highly organized and self-motivated, requiring little or no supervision to carry out duties. Ability to prioritize and execute multiple tasks to accomplish timely and effective resolution of patient accounts.
• Working knowledge of medical terminology, revenue, CPT and ICD-10 codes, and 1500 forms.
• Ability to review and completely understand an EOB, recognize problems, and communicate payer denial trends to supervisor which prohibit payment from insurance carriers.
• Ability to maintain acceptable levels of productivity with minimal errors. Requirement is 60 accounts minimum per day once training is completed.
• Strong analytical, interpersonal and communication skills required.
• Excellent PC and data entry skills essential.
• Familiarity with HIPAA privacy requirements for patient information.
• Excellent customer service skills.
• CPAR certification highly desirable.

WORKING CONDITIONS- ADA INFORMATION:

Moderate noise level. Normal business setting with moderate to high stress in accomplishing daily responsibilities. Subject to irregular schedule including evenings, nights, weekends and holidays. Occasional overtime required. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment including: copier, fax, printers, computer, telephone and adding machine. Reading of printed materials, including physician orders. Listening and verbally responding to customers, staff, physicians and visitors. Moderately heavy lifting {0-25 lbs.}, reaching, stooping, pushing, pulling, bending, and twisting.

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