Hospital Billing Specialist

Overview

Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurancefollow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledgeof UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handledenials, and perform follow-up with insurers to ensure claims resolution. The position encompasses businessoffice responsibilities related to patient accounts, including charge import, diagnostics and procedural coding,and claim follow-up with third-party payers to achieve a zero-balance resolution.

Special Instructions

Responsibilities

Billing Responsibilities

• Promote the mission, vision, and values of the organization.

• Import charges from queues in a timely manner and append modifiers or any required information for claim transmission.

• Review daily accounts that are ready to be billed in Waystar from Meditech.

• Initiate correction on all claims with errors by the designated time.

• Follow up on any correspondence that may have been received on that day or the previous day.

• Cross train on billing all lines of business to the different payers.

• Pull listing of all accounts assigned to be followed up by specific payer.

• Perform diagnostic and procedural coding.

Follow-Up Responsibilities

• Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.

• Communicate with third-party representatives as necessary to complete claims processing and/or resolve problem claims.

• Follow up daily on post-processing activity including, but not limited to, rejected billings, adjustments, rebilling, and denied claims for accounts.

• Maintain accounts receivable detail of assigned accounts through tasking.

• Maintain standards per payer for percentage of accounts greater than 90 days.

• Work minimum standard number of accounts per payer per day.

• Meet or exceed collection goals by payer each month.

• Work all assigned accounts as assigned, depending on balance.

• Participate in educational activities and attend monthly department staff meetings.

• Maintain confidentiality and adhere to all HIPAA guidelines and regulations.

• Attend educational activities and monthly department staff meetings.

• Perform other duties as assigned from time to time.

• Perform other duties as assigned.

Qualifications

Education

• High School Diploma or GED

Experience

• Six months previous experience in hospital registration, billing and collections, financial counseling, or customer service preferred.

Required Skills, Knowledge & Abilities

• Knowledge of medical terminology preferred.

• Basic computer proficiency.

• Typing speed: minimum 40 WPM.

• Familiarity with CPT and ICD-9 coding is helpful.

• Good written and verbal communication skills are essential for account follow-up.