Patient Billing Specialist — Claims & AR Expert

Prisma Health; Greenville (SC); On-site; USD 52,000 - 70,000; Full time

Job summary

Prisma Health in Greenville, SC seeks a claims billing specialist to ensure accurate and timely submission of hospital claims to payer sources. You will follow up on aging accounts, address denials, and coordinate with departments to resolve payment issues while upholding HIPAA and our standards of behavior.

Responsibilities include processing submissions, pursuing resolutions with payers and patients, and supporting ongoing improvement in patient financial services.

Qualifications

• 3 years hospital claims and billing follow-up experience.
• Understanding of hospital and physician claim forms; knowledge of payer guidelines.
• CRCA or CRCR certification preferred.
• In lieu of degree: Bachelor's degree and 2 years hospital billing experience.

Responsibilities

• Process the Billing functions, including resolving Discharged Not Final Billed/Stop Bill errors and submitting claims.
• Follow up on Specialty AR accounts to ensure payment; rebill as needed.
• Identify root causes of non-payment denials and coordinate with payers and Prisma Health departments.
• Escalate accounts to resolve payer issues and involve patients per guidelines.
• Detect system issues via trending and propose workflow changes.
• Communicate with departments to correct errors and improve cash flow.
• Contact payers, patients or guarantors at intervals to follow up on delinquent accounts.
• Meet daily productivity and quality goals; maintain accuracy and drive improvements.
• Maintain professional growth and comply with HIPAA and internal policies.
• Perform other duties as assigned.

Skills

Communication skills

Attention to detail

Education

High School diploma or equivalent

Bachelor's degree

Job description

Prisma Health in Greenville, SC seeks a claims billing specialist to ensure accurate and timely submission of hospital claims to payer sources. You will follow up on aging accounts, address denials, and coordinate with departments to resolve payment issues while upholding HIPAA and our standards of behavior.

Responsibilities include processing submissions, pursuing resolutions with payers and patients, and supporting ongoing improvement in patient financial services.