Pullman Regional Hospital is hiring a Medical Insurance Billing Specialist

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Hours: M-F 8:00 am to 5:00 pm

QUALIFICATIONS:

Education/Training:  High School Diploma or equivalent.  Prefer an Associates Degree in Business or related field.

Experience:  Medical billing experience helpful.

License/Registration:  None required.

Population Served:  N/A

ESSENTIAL FUNCTIONS:

Planning and Prioritizing

Processes daily explanation of benefits for insurance companies. Reviews and processes daily correspondence for insurance companies. Calls accounts on Aged Trial Balance; all accounts over 90 days are a priority. Calls accounts on Aged Trial Balance; all accounts over $1,000 are a priority. Posts payments for insurances for individual patient accounts. Prepares paper claims with supporting documentation and check for accuracy. Cleans all claim edits on electronic billing system checking for inconsistencies, missed charges or other billing errors. Makes any claim adjustments in the host system daily. Compiles batch information on reconciliation sheet and balances to bank deposits.

Information Gathering

Reviews credit balances and processes according to departmental policy. Obtains referral and authorization information from physician offices as necessary. Understands individual insurance company contracts and reviews reimbursements for accurateness, verifying all contractual allowances are correct. Gathers attorney billing information and works with HIM department for billing purposes.

Decision-Making

Exhausts all other resources to receive reimbursement on a claim prior to turning account balance over to the patient.  This includes calling patient/guarantor to obtain necessary documentation and/or information, and calling physicians offices for any other pertinent information. Answers client inquiries regarding any billings.

Communication

Communicates appropriately with patients, coworkers, physician offices as well as members of ancillary departments throughout the hospital and any other individuals necessary to perform essential job functions. Answers patient inquiries regarding account information. Maintains records, documentation, and account follow-up status on mainframe computer system and in the client files. Communicates payment options to patients with copay or coinsurance balances in order to receive timely payments.

Technical Proficiency

Produces and verifies for accurateness all secondary and tertiary billings making any adjustments as necessary. Produces accurate adjustments as necessary on accounts. Adjusts any account information in order to print an accurate, clean statement for patient/guarantor. Utilizes the insurance website and/or One Health Port services to verify eligibility and check claim status on appropriate financial classes. Reports bad debt payments to agencies along with other pertinent information while making necessary adjustments on agency accounts. Processes and updates all claim check rejections daily.

Teamwork

Assists other patient account representatives with questions regarding cross over claims. Assists Patient Financial Services Director with special projects or assignments as requested. Participates in monthly staff meetings and quarterly joint staff meetings between billing and registration.

Quality

Researches denials, calls insurance companies, doctors’ offices, or patient to resolve denial issues in a timely manner. Balances cash reconciliation sheet with actual batches prior to deposit.

Outcomes

Participates in committees or task forces as requested or required.

Personal Education

Attends ongoing educational activities as necessary to acquire and maintain competency in medical billing compliance by attending conferences, seminars, and reading appropriate material.

Work Effectiveness

Utilizes the reminder systems for efficient follow-up on accounts. Uses the reminder system to inform other patient account representatives of account activity.

Reliability

Demonstrates promptness in reporting to work and compliance with meal and break schedules. Completes requested information in a timely fashion. Takes initiative to do other duties as needed.

Education of Others

Educates coworkers on status and processes of accounts by payor class. Explains insurance benefits and processes to patients. Educates and assists physician’s offices when necessary and other clients when necessary.

Creating a Safe Work Environment

Identifies safety concerns and actively seeks to resolve these issues.

Stewardship

Assumes the willingness to be accountable for the well-being of the larger organization by operating in service, rather than in control, of those around us.

Ethical Conduct

Consistently communicates and collaborates with colleagues about decisions which involve legal and ethical issues.

NON-ESSENTIAL FUNCTIONS:

Performs other non-essential functions as requested.

PHYSICAL DEMANDS:

Sitting:  50%.   Standing/Walking:  50%.

Occasional lifting/carrying of supplies and paper weighing up to 40 pounds.

Occasional pushing/pulling to move supplies and equipment.

Occasional climbing of stairs to reach other levels of the building.

Occasional stooping/kneeling/bending/crouching to file in low cabinets, purge old bills and to print forms.

Occasional reaching/handling/fingering to complete paperwork, use computers, file, and answer telephones.

Frequent talking/hearing/seeing to interact with staff and customers to complete assigned tasks.

ENVIRONMENTAL CONDITIONS:

Location:  Inside.

Occasional exposure to noise from printers, telephones and fax machines.

Minimal risk of injury due to proximity of moving parts on computer printer, typewriter, and copier.

Minimal exposure to fumes and caustic materials from copy machine toner and cleaning supplies.

Minimal exposure to biohazard materials.

Pay Range:

$17.60-$26.59 Hourly

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!