Billing Specialist
Department: Revenue Cycle –CFH_10_19
Usual Schedule: M-F 8-5
Regions: Carle Foundation
On Call Requirements: NONE
Job Category: Clerical/Admin
Work Location: Carle at The Fields
Employment Type: Full –Time
Nursing Specialty:
Job Post ID: 39275
Secondary Job Category:
Experience Requirements: 1 –3 Years
Weekend Requirements: NONE
Education Requirements: Not Indicated
Shift: Day
Location: Remote
Holiday Requirements: NONE
JOB SUMMARY:
Proficient in Revenue Cycle Account Billing Specialist 1 responsibilities. Additionally, acts as a billing and reimbursement expert for defined payer product lines.
Responsible for handling escalated account and payer disputes. Handles complex edits, appeals and account activities such as bankruptcies, risk management, bad debt, lien adjudication and settlement and refund requests. Responsible for downloading, reviewing, interpreting and storing payment remittance advice in order to post insurance payments, denials, transfers and adjustments.
EDUCATIONAL REQUIREMENTS
Associates degree preferred.
CERTIFICATION &LICENSURE REQUIREMENTS
None specified.
EXPERIENCE REQUIREMENTS
One-year customer service experience in health care required or a high performer as an Account Billing Specialist 1. Credit and collection experience preferred. Proficient computer knowledge related to Microsoft Office applications such as Word, Excel, Outlook and Receivables Management systems.
SKILLS AND KNOWLEDGE
Strong written and oral communication skills;displays a high standard of confidentiality;ability to deal with a large volume of work and the ability to multitask.
Maintains a comprehensive working knowledge of assigned payer billing policies and guidelines.
Work proficiently within revenue cycle billing systems;attention for details;ability to prioritize and complete tasks under demanding conditions;ability to easily accept and implement change.
Additionally, has the ability to critically think and solve complex problems and issues with minimal or no supervision.
Knowledge of basic medical coding and third-party operating procedures and practices.
ESSENTIAL FUNCTIONS:
- Must be able to perform essential job functions of Revenue Cycle Account Billing Specialist 1.
- Handles complex edits and advanced level tasks such as but not limited to EOB balancing, credit adjustment review and processing of Illinois Worker’s Compensation Commission (IWCC) accounts.
- Handles escalated account activities such as but not limited to bankruptcies, bad debt, risk management, estate claims, fraud cases, Healthcare Liens and attorney requests.
- Handles escalated appeals.
- Responsible for sending and balancing bad debt files to outside collection agency.
- Assists with training and education to staff for accuracy.
- Identifies payer and system issues to initiate project requests for process improvements.
- Retrieves and imports electronic payment files and processes manual payments from patients and insurance carriers.
- Reviews and requests or processes and posts adjustment requests.
- Handles credit balances according to organization’s credit balance/refund policy.
- Attends and participates in meetings with payer specific provider representatives to maximize reimbursement and minimize denials through problem solving, collaboration and consensus.