Hospital Billing Specialist

Overview

Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurance

follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge

of UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle

denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business

office 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

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 follow up by specific payer

· 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, and

rebilling, and denied claims for accounts.

· Maintain accounts receivable detail of their accounts through tasking.

· Maintains standards per payer for percentage accounts >90 days.

· Works minimum standard number of accounts per payer per day.

· Meets or exceeds collection goals by payer each month.

· Works all assigned accounts as assigned, depending on balance.

· Participates in educational activities and attends monthly department staff meetings.

· Maintains confidentiality: adheres to all HIPAA guidelines/regulations.

· Other duties as assigned from time to time.

· Attend educational activities and monthly department staff meetings

· Perform other duties as assigned

Qualifications

Education

· High School Diploma or GED

Minimum Work Experience

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

Required Skills, Knowledge, and 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