Professional Billing Specialist

Shriners Children's; United States; Remote; USD 45,000 - 75,000; Full time

Job summary

An established industry player in pediatric specialty care seeks a Professional Billing Specialist to manage billing requirements and accounts receivable tasks. This role involves coordinating payor denial follow-ups, ensuring compliance with regulatory guidelines, and maintaining relationships with payer representatives. Join a compassionate organization that values excellence in patient care and offers a supportive work environment with comprehensive benefits. If you are passionate about healthcare revenue cycle management and eager to make a difference, this opportunity is perfect for you.

Benefits

Medical, dental and vision coverage

403(b) Retirement Saving Plan

Paid time off

Life insurance

Tuition reimbursement

Pet insurance

Short and long-term disability

Flexible Spending Account (FSA)

Qualifications

• 5 years experience in Healthcare/Hospital Revenue Cycle Environment.
• Epic PB Resolute experience is a must, along with intermediate Excel skills.

Responsibilities

• Manage all professional billing requirements and accounts receivable tasks.
• Coordinate payor denial and appeal follow-up activities.

Skills

Healthcare Revenue Cycle Management

Epic PB Resolute

Excel

Understanding of CCI edits

Communication Skills

Education

Bachelor’s Degree

Equivalent combination of education and experience

Tools

SQL

Crystal Reports

Job description

Company Overview

Shriners Children’s is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

All employees are eligible for medical, dental and vision coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a full-time or part-time status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans. Additional benefits available to full-time and part-time employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

Job Overview

The Professional Billing Specialist is responsible for managing all professional billing requirements and managing accounts receivable tasks according to standard and productivity measurements. Responsible to ensure all regulatory and payor guidelines are followed.

Responsibilities

• Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors and the processing of all payor denials, documentation requests and appeals
• Review all denial accounts for categorization, level of appeal, special requirements for initiating appeals
• Communicate global payer issues with the payer relations team.
• Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to appeal follow up and denials.
• Maintaining the healthcare tracking tool/application that stores/communicates all claim edits, review and denial activity. This will include user access management, updates to software, and end-user training to support all follow up activities.
• Monitor all Claim Edit and Denial Management work queues and lists to ensure they are fully resolved.
• Ensure medical records requests are completed and submitted within 48 hours.
• Track all denials on a database to determine outcome. Collecting/analyzing, report status, metrics and trends of activity by different reviews from the tool. Distributing reports on a routine basis to specific distribution group.
• Organizing all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors. Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
• Knowledgeable about federal, state and third-party claims processing. Supporting projects and initiatives of the Billing and Denials Management teams. This may include coordinating meetings, conducting research for payor criteria, and preparing documents
• Able to build and maintain relationships with payer representatives

This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Qualifications

Minimum:

• Epic PB Resolute experience
• 5 years' experience in a Healthcare/Hospital Revenue Cycle Environment including Third Party Collection/AR Receivables
• Healthcare Revenue Cycle revenue management EDI Transaction sets including 837P
• Knowledge of insurance contract rates and terms
• Understanding of Registration and Collections
• Understanding of Government and Managed Care billing, coverage and payment rules Ability to comprehend payor 835 and paper EOB responses
• Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes
• Intermediate Excel skills
• Excellent computer skills, especially spreadsheet and database applications.
• Knowledge of managed care patient financial systems and of the specific billing and payment standards utilized for services provided within a hospital setting.
• Thorough understanding of managed care payment methodologies and the principles of managed care.
• Certification in Epic PB Resolute - or agree to obtain certification within 12 months after hire
• Bachelor’s Degree or equivalent combination of education and experience

Preferred:

• Knowledge of SQL or Crystal Reports.
• HFMA’s CRCR credential