Schedule: FT, Mon - Fri, 8:00am - 5:00 pm, flexible

At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview

The billing specialist ensures, through various activities, that claims are clean and should be paid promptly by insurers without requiring additional information. This staff member performs all claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. The billing specialist's activities result in claims that can be submitted to payers without further intervention.

Essential Functions

• Reviews and files all claims in accordance with Central Billing Office policies and procedures and to make sure that payer specific billing requirements are met. Investigates any discrepancies and makes corrections where needed. Corrects all accounts in error or on hold within established timeline of receipt. Resolves bill holds on accounts. Conducts quality audits of patient demographic information and insurance eligibility, cross-referencing with previous treatment records if possible, and correcting discrepancies. This includes verifying benefits and coverage prior to claim submission for accounts in Retro Review Work queue and charge review work queues. Ensures late charges are field per payer and timely filing guidelines; requests additional information from appropriate staff members when needed. Detects any other issues that could affect payment; works with appropriate staff members in other departments to ensure claims are ready for billing Prepares required clinical documentation and/or itemized statements for submission with claims. Educates staff in other departments when existing documentation is not sufficient for billing Organizes all claims for electronic or hard copy mail and forwards to appropriate third party payers.

• Processes claims and rejections by entering into system, moving to appropriate bucket, and directing to appropriate area for resolution. Identifies possible billing edits, denials, and rejection trends such as adjusted length of stay discrepancies, and reports findings to supervisor. Answers billing inquiries. Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats. Reconciles daily billing reports to payor confirmation reports if applicable for assigned area. Adjust claims following audit acceptance to ensure accurate billing. Escalates accounts as necessary Communicates with payers to resolve anticipated issues, Keeps current on payor requirements though workshops, newsletters, and websites.

• Regular attendance at work is an essential function of the job.

• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• High School Diploma or GED equivalent Required and

• Associate's Degree in Billing, Coding, Business, Finance, or related filed Preferred

Experience Qualifications

• Minimum 2 years of experience working with commercial or government billing and reimbursement processes or Associate’s degree in Billing, Coding or HIM Required

Skills and Abilities

• Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities

• Knowledge of hospital and professional billing, collection and reimbursement requirements and standard practice.

• Ability to review, interpret and understand managed care contracts with third-party payors.

• Intermediate computer skills including the use of spreadsheet programs and word processing programs.

• Strong interpersonal skills with attention to detail and ability to organize, interpret, and present data.

• Excellent oral and written communication skills as this position will deal directly with the public daily.

Children’s is the very best for kids and the very best for your career! At Children’s, we put YOU first so together, we can improve the life of every child!

Requisition ID : 21533