INSURANCE BILLING SPECIALIST, PATIENT FINANCIAL SERVICES
South Georgia Medical Center, Valdosta, GA, United States
Overview
Description
What it's like at SGMC Health
Purpose : No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.
Excellence : We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.
Team Spirit : We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.
Award Winning Performance : We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.
Benefits
Low Healthcare Insurance Premiums
401(k) with employer match
Paid Time Off (PTO)
Employee discounts
Company paid life insurance
Short-Term and Long-Term Disability
Cancer Insurance
Accident Insurance
Pet Insurance
Tuition Reimbursement
On-the-job training and skills development
Opportunities for growth and advancement
Employee Assistance Program
Details
JOB LOCATION:
SGMC Patient Financial Services
DEPARTMENT:
PATIENT FINANCIAL SERVICES
SCHEDULE:
Full Time, 8 HR Day Shift
Responsibilities
Position Summary: Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. Verifying patients’ insurance coverage. Answering billing questions from internal and external customers. Responsible for the timely billing, correction of edits, follow up of unpaid balances, and appealing of denials of hospital charges. Verifying patient’s insurance coverage and benefits. Answering billing questions from internal and external sources. Responsible for subset of payers and/or alpha split of payer groupings. Will be accountable for the overall health of the accounts receivables assigned. Responsible for daily review of correspondence, outstanding insurance credit balances, over-posted account balances, and paid claims with outstanding balances.
Qualifications / Knowledge, Skills & Abilities
Prior hospital billing experience recommended.
Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system.
Submits claims in Epic HB Resolute Billing system.
Documents and updates status of unpaid insurance balances.
Researches and analyzes billing reference manuals to review billing accuracy.
Documents electronic system regarding returned faxes and Certified Return Receipts. Completes production logs. Processes outgoing mail.
Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems.
Technical/system skills: PC and Windows literacy; knowledge of Medicare, Medicaid, and other payer web portals, Craneware, Microsoft Office applications, and Experian claim source clearinghouse portal.
Extensive knowledge of insurance/managed care, including Medicare, Medicaid (GA and FL), Peach State, Wellcare, CareSource, Amerigroup; Tricare; VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; various Managed Care plans; COBRA; Worker’s Compensation; Blue Cross (GA, FL, out-of-state and FEP); Institutional Billing.
Working knowledge of CPT-4, HCPCS, and ICD-10.
Knowledgeable of insurance and reimbursement process.
Understanding of patient type, financial class, insurance master, place of service codes, relationship codes, accommodation, occurrence, value and condition codes.
Regulatory and legal requirements related to Medicare Secondary Payer, medical necessity, medical reviews and appeals.
Interacts with patients, other departments, insurance companies, employers, intermediaries, utilization review companies, state regulatory agencies, and attorneys.
Knowledge of medical terminology. Strong verbal/written communication, highly organized with the ability to prioritize work.
Ability to communicate with a wide range of individuals; prioritization and multitasking to resolve patient accounts.
Working knowledge of medical terminology, revenue, CPT and ICD-10 codes, and 1500 forms.
Ability to review and understand an EOB, recognize problems, and communicate payer denial trends to supervisor.
Maintain acceptable productivity with minimal errors; typical goal of 60 accounts minimum per day after training.
Strong analytical, interpersonal and communication skills. Excellent PC and data entry skills. Familiarity with HIPAA privacy requirements. Excellent customer service skills.
CPAR certification highly desirable.
Working Conditions
Moderate noise level. Normal business setting with moderate to high stress in accomplishing daily responsibilities. Subject to irregular schedule including evenings, nights, weekends and holidays. Occasional overtime required. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment. Reading of printed materials. Listening and verbally responding to customers, staff, physicians and visitors. Moderate physical activity including lifting up to 25 lbs, reaching, stooping, pushing, pulling, bending and twisting.
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Description
What it's like at SGMC Health
Purpose : No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.
Excellence : We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.
Team Spirit : We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.
Award Winning Performance : We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.
Benefits
Low Healthcare Insurance Premiums
401(k) with employer match
Paid Time Off (PTO)
Employee discounts
Company paid life insurance
Short-Term and Long-Term Disability
Cancer Insurance
Accident Insurance
Pet Insurance
Tuition Reimbursement
On-the-job training and skills development
Opportunities for growth and advancement
Employee Assistance Program
Details
JOB LOCATION:
SGMC Patient Financial Services
DEPARTMENT:
PATIENT FINANCIAL SERVICES
SCHEDULE:
Full Time, 8 HR Day Shift
Responsibilities
Position Summary: Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. Verifying patients’ insurance coverage. Answering billing questions from internal and external customers. Responsible for the timely billing, correction of edits, follow up of unpaid balances, and appealing of denials of hospital charges. Verifying patient’s insurance coverage and benefits. Answering billing questions from internal and external sources. Responsible for subset of payers and/or alpha split of payer groupings. Will be accountable for the overall health of the accounts receivables assigned. Responsible for daily review of correspondence, outstanding insurance credit balances, over-posted account balances, and paid claims with outstanding balances.
Qualifications / Knowledge, Skills & Abilities
Prior hospital billing experience recommended.
Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system.
Submits claims in Epic HB Resolute Billing system.
Documents and updates status of unpaid insurance balances.
Researches and analyzes billing reference manuals to review billing accuracy.
Documents electronic system regarding returned faxes and Certified Return Receipts. Completes production logs. Processes outgoing mail.
Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems.
Technical/system skills: PC and Windows literacy; knowledge of Medicare, Medicaid, and other payer web portals, Craneware, Microsoft Office applications, and Experian claim source clearinghouse portal.
Extensive knowledge of insurance/managed care, including Medicare, Medicaid (GA and FL), Peach State, Wellcare, CareSource, Amerigroup; Tricare; VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; various Managed Care plans; COBRA; Worker’s Compensation; Blue Cross (GA, FL, out-of-state and FEP); Institutional Billing.
Working knowledge of CPT-4, HCPCS, and ICD-10.
Knowledgeable of insurance and reimbursement process.
Understanding of patient type, financial class, insurance master, place of service codes, relationship codes, accommodation, occurrence, value and condition codes.
Regulatory and legal requirements related to Medicare Secondary Payer, medical necessity, medical reviews and appeals.
Interacts with patients, other departments, insurance companies, employers, intermediaries, utilization review companies, state regulatory agencies, and attorneys.
Knowledge of medical terminology. Strong verbal/written communication, highly organized with the ability to prioritize work.
Ability to communicate with a wide range of individuals; prioritization and multitasking to resolve patient accounts.
Working knowledge of medical terminology, revenue, CPT and ICD-10 codes, and 1500 forms.
Ability to review and understand an EOB, recognize problems, and communicate payer denial trends to supervisor.
Maintain acceptable productivity with minimal errors; typical goal of 60 accounts minimum per day after training.
Strong analytical, interpersonal and communication skills. Excellent PC and data entry skills. Familiarity with HIPAA privacy requirements. Excellent customer service skills.
CPAR certification highly desirable.
Working Conditions
Moderate noise level. Normal business setting with moderate to high stress in accomplishing daily responsibilities. Subject to irregular schedule including evenings, nights, weekends and holidays. Occasional overtime required. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment. Reading of printed materials. Listening and verbally responding to customers, staff, physicians and visitors. Moderate physical activity including lifting up to 25 lbs, reaching, stooping, pushing, pulling, bending and twisting.
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