Senior Government Account Specialist

Coral West Community Hospital; Miami (FL); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Coral West Community Hospital in Miami seeks a billing specialist to coordinate billing and collections, with knowledge of physician billing, insurance collections experience, and proficiency in ICD-10 and CPT coding.

Responsibilities include processing EDI and ERA files, submitting claims, reconciling denials, contacting insurers, and ensuring accurate billing data while maintaining patient privacy and compliance.

Qualifications

• 2+ years of medical billing and collections experience.
• Knowledge of insurance carrier payment policies and practices.
• Familiarity with the DDE system.
• Detail-oriented with strong organizational skills.
• Ability to prioritize and work under pressure.

Responsibilities

• Coordinate billing and collection activity for the hospital.
• Process EDI transactions and ERA files; reconcile submissions.
• Verify accuracy of billing data and correct errors.
• Create itemized statements, bills, and invoices.
• Follow-up with insurance carriers on outstanding balances.
• Manage denials, appeals, and corrected claims.
• Maintain Medicare/Medicaid demographics and guidelines.

Skills

Medical billing

EDI processing

ICD-10 CPT

Insurance collections

Denials management

DDE system

Communication skills

Education

Accounting degree

Tools

HMS

Job description

Responsible for coordinating billing and collection activity. This individual must have knowledge of the physician billing process and insurance collections experience.

Essential Functions

Responsible for working EDI transactions and ERA files, including reconciling carrier submissions, edits and rejection reports.

Verifies accuracy of billing data, correcting any errors.

Creates itemized statements, bills, invoices, and other necessary billing documents.

Must be proficient in ICD-10, CPT coding and proper use of modifiers.

Contacts insurance companies for claim status on outstanding balances due from carriers.

Obtains necessary documentation required to submit to insurance to expedite payments.

Documents accurate collection activity utilizing guidelines in place.

Processes any insurance correspondence.

Tracks denials for no authorizations.

Attempts to resolve and de-escalate any billing inquiries.

Claims transmission from HMS to the clearinghouse.

Clearinghouse edits and rejection resolution.

Medicare Advantage IME billing.

DDE processing and Medicare system navigation.

Follow-up of Medicaid authorizations and retro authorizations.

Collections and follow-up on government inpatient and outpatient claims.

Claim follow-up via phone calls and IVR systems.

Denials management and appeals.

Corrected claims and rebilling.

Medicare/Medicaid demographic and MBI maintenance.

Coordination with EQHealth and MMS.

Commercial inpatient psych billing related to Medicare/Medicaid populations.

Ongoing maintenance and application of current CMS billing guidelines and regulations.

Manages the full life cycle of accounts independently, including billing, collections, denial resolution, appeals, edits, and system maintenance.

Experience Required

2+ years of previous medical billing and collections experience.

Knowledge of insurance carrier payment policies, practices, and amounts.

Knowledge of Utilize the DDE system.

Logical and efficient, with keen attention to detail.

Highly self-motivated and directed.

Ability to effectively prioritize and execute tasks while under pressure.

Excellent listening, interpersonal, written, and oral communication skills.

Knowledge of insurance carrier policies and practices.

Experience working in a team-oriented, collaborative environment.

Able to manage multiple concurrent tasks.

Flexible to handle unexpected daily challenges.

Skills and Abilities

Demonstrates knowledge of financial accounting, processing and distribution.

Performs in a calm and professional manner during crisis and emergency situations.

Ability to assess the needs of a job function and adjust accordingly.

Understand and use professional and technical language and symbols.

Use eyes, hands, and fingers to operate delicate and sensitive equipment.

Work precisely and accurately.

Use measurable and verifiable information for making decisions or judgments.

Ability to estimate and determine time and resources needed for the good functioning of the department.

Able to get along with coworkers, visitors, supervisors, etc.

Physical Demands

Medium work: Exerting up to 20 to 50 pounds of force frequently, up to 1/3 of the time to move objects. Requires walking or standing to a significant degree and requires sitting a minimal amount of time.

Environmental Conditions

Inside: Protection from weather conditions but not necessarily from temperature changes.

Reasoning Development

Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions. Interpret an extensive variety of technical instructions in mathematical or diagrammatic form. Deal with problems involving several abstract and concrete variables in and from standardized situations.

Mathematical Development

Add, subtract, multiply and divide all units of measure. Perform the four operations with like common and decimal fractions. Compute ratio, rate and percent. Draw and interpret bar graphs. Perform arithmetic operations involving all American monetary units.

Language Development

Reading: Read and understand instructions and other written materials such as policies, procedures, etc.

Writing: Write letters, correspondence and other reports with proper format, punctuation, spelling and grammar, using all parts of speech.

Speaking: Speak with poise, voice control, and confidence using correct English and well-modulated voice.

Relationships with Data, People and Things

Data: Compiling: Gathering, collating, or classifying information about data, people or things. Reporting and/or carrying out a prescribed action in relation to information is frequently involved.

People: Speaking-Signaling: Talking with and/or signaling people to convey or exchange information. Includes giving assignments, instructions and/or directions to helpers, subordinates or assistants.

Job Knowledge

Comprehensive knowledge of general accounting and financial management theory, practice and procedures. Ability to provide leadership and serve as a liaison between administration and staff.

Qualification

To do this job, you must have the following amount of total education and/or experience:

Accounting degree is desirable with experience in Hospital accounting/business office background preferred.