Commercial Billing Specialist

Under direct supervision, performs all billing and collection functions on account balances within assigned financial classes. Ensures timely submission of all claims and timely follow up. Posts payments in EPIC. Perform eligibility, verification and authorization requests, as needed.

Education

High School diploma or equivalent required.  Associate’s degree preferred.

Experience

Two years of medical billing experience and one year experience with electronic billing.

Epic experience desired.

Knowledge, Skills and Abilities

• Thorough knowledge and understanding of  medical billing, insurance and private pay.
•  Knowledge of all medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriers
• Strong collection skills, including claims follow-up, revenue cycle practices
• Strong computer skills, including EMR knowledge and Microsoft Office.  Excel preferred.
• Strong interpersonal skills 
• Excellent verbal and written communication skills for interacting with patients, families, insurance companies and healthcare providers.
• Strong ability to investigate issues, find solutions, and work under pressure to resolve billing issues.
• Efficient in managing multiple tasks, prioritizing, and ensuring deadlines are met.
• Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracy

Licensures, Certifications

N/A

Principal Duties and Responsibilities

• Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.

Claims Billing Processes

• Ensures timely submission of all claims within assigned financial classes.
• Ensures timely follow up of all claims within assigned financial classes

Claim Resolution Processes

• Investigates claim denials or rejections
• Completes functions in order to resolve claims

• Uses all available tools such as but not limited to:  Online access, calling the insurance companies; working with provider representatives.
• Identifies appeals
• Identifies secondary billing for  accounts with secondary liability; follows-up on any unpaid balances.  Brings these claims to resolution. 
• Identifies patient self-pay balances and bills timely to patient/family.  Follow-ups as necessary including calling for follow up.
• Process any late charge claims, claims resubmission and/or claims corrections to payors.
• Enters and posts payment to patient accounts based on remittance advice review.
• Reconcile accounts and ensure any underpayments or overpayments are corrected
• Responds to patient and third-party payor inquiries regarding patient accounts via e-mail, telephone, mail, and in person.
• Audits primary patient bills for submission to third party payers via electronic billing or manual claim submission.
• Maintain detailed and accurate billing records for auditing purposes and compliance with industry regulations
• Maintain thorough records of all communication with insurance providers and patients regarding claims.
• Participate in meetings with Provider Reps to resolve denial discrepancies
• Prepare and submit appeals for denied claims.  Understanding of additional documentation necessary to submit an appeal
• Obtain an in-depth understanding of hospice billing regulations.  Ensure compliance with federal, state and local billing laws, including HIPAA regulations.
• Prepare reports to managers recommending accounts for bad debt adjustments.  Maintaining lost revenue at a level of less than 1% of net healthcare revenue
• Recommends accounts for transfer to bad debt.

Physical Requirements

• Ability to sit, concentrate and pay close attention to detail

Working Conditions

• Normal office environment with little exposure to excessive noise, dust, temperatures and the like

Conditions of Employment

N/A

All roles must demonstrate GBMC Values

GBMC Values

Value Description

Respect

I will treat everyone with courtesy. I will foster a healing environment.

• Treats others with fairness, kindness, and respect for personal dignity and privacy
• Listens and responds appropriately to others’ needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

• Meets and/or exceeds customer expectations
• Actively pursues learning and