Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurancefollow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledgeof UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handledenials, and perform follow-up with insurers to ensure claims resolution. The position encompasses businessoffice responsibilities related to patient accounts, including charge import, diagnostics and procedural coding,and claim follow-up with third-party payers to achieve a zero-balance resolution.
Special InstructionsThis position has the possibility of being hybrid schedule or remote after 6 months, per mgrs. discretion. ResponsibilitiesBilling Responsibilities• Promote the mission, vision, and values of the organization.
• Import charges from queues in a timely manner and append modifiers or any required information for claim transmission.
• Review daily accounts that are ready to be billed in Waystar from Meditech.
• Initiate correction on all claims with errors by the designated time.
• Follow up on any correspondence that may have been received on that day or the previous day.
• Cross train on billing all lines of business to the different payers.
• Pull listing of all accounts assigned to be followed up by specific payer.
• Perform diagnostic and procedural coding.
Follow-Up Responsibilities• Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
• Communicate with third-party representatives as necessary to complete claims processing and/or resolve problem claims.
• Follow up daily on post-processing activity including, but not limited to, rejected billings, adjustments, rebilling, and denied claims for accounts.
• Maintain accounts receivable detail of assigned accounts through tasking.
• Maintain standards per payer for percentage of accounts greater than 90 days.
• Work minimum standard number of accounts per payer per day.
• Meet or exceed collection goals by payer each month.
• Work all assigned accounts as assigned, depending on balance.
• Participate in educational activities and attend monthly department staff meetings.
• Maintain confidentiality and adhere to all HIPAA guidelines and regulations.
• Attend educational activities and monthly department staff meetings.
• Perform other duties as assigned from time to time.
• Perform other duties as assigned.
QualificationsEducation• High School Diploma or GED
Experience• Six months previous experience in hospital registration, billing and collections, financial counseling, or customer service preferred.
Required Skills, Knowledge & Abilities• Knowledge of medical terminology preferred.
• Basic computer proficiency.
• Typing speed: minimum 40 WPM.
• Familiarity with CPT and ICD-9 coding is helpful.
• Good written and verbal communication skills are essential for account follow-up.
Skills Required
- High school diploma or GED
- Six months of experience in hospital registration, billing and collections, financial counseling, or customer service
- Knowledge of medical terminology
- Basic computer proficiency
- Typing speed of at least 40 WPM
- Familiarity with CPT and ICD-9 coding
- Good written and verbal communication skills
- Understanding of insurance claim processing, UB and HCFA claim forms, EOBs, denials, and payer follow-up
What We Do
Appalachian Regional Healthcare (ARH) is a not-for-profit health system serving Central Appalachia through 14 hospitals in Kentucky and West Virginia, along with multispecialty physician practices, home-health agencies, home-medical-equipment stores, retail pharmacies, and medical spas. Its mission is to improve health and promote well-being in partnership with regional communities, while providing broad rural healthcare services and investing in medical capabilities.
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