Billing Specialist

· Utilizes various hospital/physician systems to verify patient, billing and claim information for accuracy.
· Performs compliant primary/secondary, tertiary and re-bill billing functions, including electronic, paper and portal submission to government and/or commercial payers.
· Edits claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission.
· Responds timely to emails and telephone messages, as appropriate.
· Communicates issues to management, including payer, system or escalated account issues.
· Participates and attends meetings and training seminars, as requested.
· Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards.
· Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
· Updates patient demographics/insurance information in appropriate systems.
· Monitors claims for missing information, authorization and control numbers (ICN//DCN).
· Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
· Secures needed medical documentation required or requested by third party insurance carriers.
· Maintains and respects the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure.

In addition:
· Utilize provider billing manuals to obtain billing guidelines and requirements
· Import verification and escalation of import/export files
· Special Handling billing included not limited to interim bills, overlap review, redistribution of money for correct claim creation
· Resolve and research billing Rejections