Summary

The main objective of this position is to ensure correct processing of all insurance claims of all hospital. Able to interpret & implement specified insurance billing guidelines. Coordinates all facets for insurance billing. credits and collection of A/R. This role ensures duties are completed accurately and timely while acting as a team player for optimum office flow and excellent patient service.

Responsibilities

• Responsible for clear, detailed communication with the clinical and billing staff along with payers and clients regarding various insurance and payment related issues

• Bill and submit claims for all insurance companies according to payer specific guidelines and established procedures and workflow. Be knowledgeable of payer updates as it relates to bundling and unbundling charges, medical necessity and general coding specifications.

• Review and process adjustments as needed for accounts to avoid claim release if not needed but also recognizes and resolves credit balances as needed.

• Able to resolve all front end claim edits and clearinghouse returns so that clailm can be resubmitted in a timely matter to payers/insurance carriers.

• Responsible daily for the correction of primary/secondary rejected claims, the resubmission of rejected claims in along with resolution of all delinquent insurance claim on patient accounts, per guidelines, in order to secure payment

• Completes all assigned goals

• Assists the Supervisor with other functions

Requirements, Preferences and Experience

Education

Preferred: One to 3 years medical claims billing or processing with some college, vocational or certification in the insurance industry.

Experience

Preferred: Experience in medical billing, previous employment in the insurance industry, or professional certification, three to five years preferred.

Minimum: Strong verbal and written skills Must be able to work independently within assigned guidelines Shows initiative and enjoys working as a team in a fast paces and stressful environment with strong attention to details. At least one year in a hospital/physician business office setting.

Special Skills

Preferred: Knowledge of ICD-9/ICD-10, CPT and HCPCS codes, Compliance, OSHA, and HIPPA regulations.

Minimum: Ability to read, understand, interpret and resolve payer front end denials Ability to research payer regulations and determine appropriate claim submissions Ability to utilize multiple patients accounting and billing applications including but not limited to connect systems, claims clearing house systems, payer systems, internet. Ability to interface with the staff at the insurance carriers and hospital personnel. Ability to read, write and understand documents, correspondence, and memos Ability to effectively present information one-to-one and in group situations to customers, clients, and other employees in the organization Critical thinking skills required Effective PC skills

Training

Preferred: Experience with MS Word, Excel and ability to learning new computer programs

Minimum: PC Skills Keyboarding 35-50 words per minute

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:

• Competitive salaries

• Paid vacation/time off

• Continuing education opportunities

• Generous retirement plan

• Health insurance, including dental and vision

• Sick leave

• Service awards

• Free parking

• Short-term disability

• Life insurance

• Health care and dependent care spending accounts

• Education assistance/continuing education

• Employee referral program

Job Summary:

Position: 5595 - Specialist-Billing Senior

Facility: BMG - Central Business Office

Department: MG CBO Billing

Category: Billing Claims and Revenue

Type: Non Clinical

Work Type: Full Time

Work Schedule: Days

Location: US:TN:Memphis

Located in the Memphis metro area REQNUMBER: 23776