Sr. Billing Specialist

Rhode Island Hospital; United States; On-site; USD 30,000 - 50,000; Full time

Job summary

Brown University Health is seeking a Senior Billing Specialist to perform patient account verification and claims research against payer specifications. The role includes resolving insurance denials and analyzing CPT/ICD-10 coding, with daily interactions across departments.

Ideal candidates have 4+ years in medical billing, strong problem-solving skills, and experience with CPT, ICD-10, and HCPCS coding. Location is Providence, RI; standard daytime hours apply.

Qualifications

• High school diploma or equivalent; CPT4/ICD-9/10 and HCPCS knowledge; reimbursement policies.
• Experience with medical billing in a fast-paced office or billing service.
• Strong analytical and problem-solving skills for denials and coding issues.

Responsibilities

• Research claims in the system and verify patient information against payer specifications.
• Follow up on payer denials to ensure proper re-processing of rejected claims.
• Analyze coding of procedures and diagnoses using ICD-10 and CPT codes.
• Review bills prepared by others to correct errors; coordinate with other departments to resolve issues.
• Obtain and verify accurate patient registration information; respond to billing inquiries promptly.

Skills

CPT4 coding

ICD-10 coding

HCPCS knowledge

claims processing

customer service

research and problem solving

Education

High school diploma or equivalent

Tools

Billing software

Job description

SUMMARY:

Under general supervision of the Office Manager, the Sr Billing Specialist performs related clerical duties including review and verification of patient account information against insurance program specifications and coding review. Researchesnvestigates high dollar claims and denials from third party payers and resolves patient/client billing inquiries. Follow up on balances due from insurance companies and analyzes surgical procedure authorizations involving ICD-10 &CPT codes.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

• Instill Trust and Value Differences
• Patient and Community Focus and Collaborate

RESPONSIBILITIES:

• Performs patient insurance billing duties such as researching claims in system, including review and verification of patient account information against insurance program specifications. Recognizes and identifies source of entry in complex multi facility organization.
• Follows up on payer claims denials to ensure proper re-processing of rejected claims, when appropriate.
• Analyzes and resolves problems with coding of surgical procedures and diagnosis using ICD-10, CPT coding.
• Reviews reports, records and/or bills that were prepared or assembled by others in order to ensure that information is correct. Contacts other departments or personnel as necessary to resolve errors and omissions.
• Obtains patient registration information. Courteously and accurately completes patient registration.
• Confers with representatives of third-party payers to resolve billing issues and to discuss changes in regulations/policies affecting billing system.
• May download bills from system to assist with disputed claims.
• Responds to patient billing inquiries in a timely, courteous manner.
• Keeps current with billing guidelines.
• Performs other related duties as assigned.

MINIMUM QUALIFICATIONS:

BASIC KNOWLEDGE:

High school level of knowledge or equivalent. Experience with CPT4, ICD-9/10, HCPCS, coding guidelines as well as reimbursement policies and procedures.

EXPERIENCE:

4+ years' experience in a fast-paced medical office or billing service environment; familiar with aspects of third-party billing. Experience must demonstrate thorough knowledge of medical billing and claims processing, effective customer service experience, medical and procedure coding, medical terminology, knowledge of personal computers and critical thinking. Experience should represent familiarity with coding principles of CPT, ICD-10 coding and related terminology for hospital billing. Analytical ability to research and resolve billing problems and to analyze billing activity.

WORK ENVIRONMENT ANDPHYSICAL REQUIREMENTS:

Work is performed in a physician office practice billing environment.

INDEPENDENT ACTION:

Incumbent follows general office procedures and policies. Complexities are referred to Patient Financial Services.

SUPERVISORY RESPONSIBILITY:

None.

Pay Range: $22.04-$36.37

EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location: Brown Health Medical Group - 167 Point Street Providence, Rhode Island 02903

Work Type: M-F 8:00am-5:00pm

Work Shift: Day

Daily Hours: 8 hours

Driving Required: No