KNOWLEDGE/EXPERIENCE: 

Previous work experience in insurance billing regulations and understanding insurance contracts preferred but not mandatory Knowledge of state and federal regulations as they relate to the billing process preferred but not mandatory  Proficient keyboard/ 10 key skills and working knowledge of computers required.  Good verbal and written communication skills.  Strong data entry, ten key skills and working knowledge of computer required.  Exceptional customer service and interpersonal communication skills. Proficient in examining documents for accuracy and completeness. Ability to multitask and manage time effectively. Ability to grasp, retain, and apply new regulations Mathematical, organization skill and business correspondence skills.  Basic knowledge in downloading/creating spreadsheets in Microsoft Excel

EDUCATION:    High School diploma or GED required. Completes Patient Financial Services I training within first 5 month

Performs pre-billing and billing functions to insure successful outcome of claim submission and payment. Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance. Collaborates with all Team Members within SPH to insure an accurate and timely billing.  Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership Utilize various A/R reports to target aged balances for collection to meet and maintain performance goals. Evaluate partial payments to determine if further reimbursement is valid Compose technical denial arguments for reconsideration, including both written and telephonically Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument Escalate exhausted appeal efforts to Leadership Submits retro authorization to insurance within insurance carrier guidelines Researches and takes necessary action to follow up on unpaid claims using ATB’s and/or assigned work lists Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess  Use effective documentation standards that support a strong historical record of actions taken on the account Reviews and follows through on credit balances through take back initiation, refund initiation, and/or payment re-application. Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports. Works patient and insurance correspondence timely. Respond and document in account and scan documents into patient account for future reference. Response to all queries timely to insure Gold Standard Customer Service   Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations