GENERAL OVERVIEW:
This job processes pro-fee billing activities.
ESSENTIAL RESPONSIBILITIES:
- Posts co-payments, patient payments, and insurance company payments (paper and electronic), and denials. Performs reconciliation of payments. Prepares and deposits payments received.
- Uses CPT, ICD-9, and payer specific codes and modifiers to prepare and enter charges for entry (includes office, hospital, and outpatient charges).
- Assists customers with patient billing inquiries. Identifies unpaid balances (insurance and patient) through A/R reports and takes appropriate actions.
- Obtains and enters patient demographic, insurance, and referral/precertification information in the billing system.
- Verifies insurance information via hospital and insurance carrier systems. Ensures that electronic and paper claims are sent to insurance carriers in a timely manner.
- Maintains current knowledge of federal and state reimbursement policies/regulations and system policies pertaining to billing. Ensures compliance with regulatory requirements.
- Performs all other duties as assigned, including but not limited to supporting front end office processes.
QUALIFICATIONS:
Minimum
- High school diploma or GED; or one to three months related experience and/or training; or equivalent combination of education and experience.
- 1-3 years’ healthcare billing experience.
Preferred
- Graduate of a medical billing program.
- Medical Records training and OASIS education.
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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For accommodation requests, please contact HR Services Online at [email protected]
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Skills Required
- High school diploma or GED (or equivalent combination of education and experience)
- 1-3 years healthcare billing experience
- Experience posting patient/copay/insurance payments and performing payment reconciliation
- Knowledge of CPT, ICD-9, payer-specific codes and modifiers for charge entry
- Ability to obtain and enter patient demographic, insurance, and referral/precertification information
- Familiarity with sending electronic and paper claims and verifying insurance via carrier systems
- Knowledge of federal and state reimbursement policies, billing regulations, and HIPAA compliance
- Graduate of a medical billing program
- Medical Records training and OASIS education
Highmark Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Highmark Health and has not been reviewed or approved by Highmark Health.
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Healthcare Strength — Medical, prescription, dental, and vision coverage are emphasized alongside 100% coverage for preventive exams, with onsite pharmacy access and fitness center availability at major campuses.
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Retirement Support — An employer‑sponsored 401(k) with a company match is highlighted, with AHN materials illustrating a 100% match on the first 4% plus an additional 1% employer contribution as an example within the enterprise.
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Wellbeing & Lifestyle Benefits — Wellness programs include stress‑management classes, health coaching, incentives for healthy activities, team‑member discounts, and volunteer incentives, with paid volunteer time also noted in the overall package.
Highmark Health Insights
What We Do
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people who serve millions of Americans across the country, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions. We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
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