Billing Specialist

🕒 Janeiro 14

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Shriners Children's

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1922

⚕️ Seguro de Saúde

🤝 Sem Fins Lucrativos

🔬 Ciência

Healthcare Insurance • Non-profit • Science

A Shriners Children's é uma organização sem fins lucrativos que oferece cuidados pediátricos especializados há mais de 100 anos. Com um compromisso com a excelência, sua equipe compassiva de médicos e enfermeiros foca em fornecer atendimento personalizado em várias especialidades, incluindo cuidados para queimaduras, ortopedia e reabilitação pediátrica. Eles também se envolvem em pesquisas inovadoras destinadas a melhorar os tratamentos médicos e a qualidade de vida das crianças.

Descrição

• Managing all professional billing requirements and managing accounts receivable tasks according to standard and productivity measurements. • Ensure all regulatory and payor guidelines are followed. • Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors and the processing of all payor denials, documentation requests and appeals. • Review all denial accounts for categorization, level of appeal, special requirements for initiating appeals. • Communicate global payer issues with the payer relations team. • Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to appeal follow up and denials. • Maintaining the healthcare tracking tool/application that stores/communicates all claim edits, review and denial activity. • Monitor all Claim Edit and Denial Management work queues and lists to ensure they are fully resolved. • Ensure medical records requests are completed and submitted within 48 hours. • Track all denials on a database to determine outcome. • Collecting/analyzing, report status, metrics and trends of activity by different reviews from the tool. • Distributing reports on a routine basis to specific distribution group. • Organizing all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors. • Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc. • Supporting projects and initiatives of the Billing and Denials Management teams. This may include coordinating meetings, conducting research for payor criteria, and preparing documents. • Able to build and maintain relationships with payer representatives.

🎯 Requisitos

• Epic PB Resolute experience • 5 years' experience in a Healthcare/Hospital Revenue Cycle Environment including Third Party Collection/AR Receivables • Healthcare Revenue Cycle revenue management • EDI Transaction sets including 837P • Knowledge of insurance contract rates and terms • Understanding of Registration and Collections • Understanding of Government and Managed Care billing, coverage and payment rules • Ability to comprehend payor 835 and paper EOB responses • Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes • Intermediate Excel skills • Excellent computer skills, especially spreadsheet and database applications. • Knowledge of managed care patient financial systems and of the specific billing and payment standards utilized for services provided within a hospital setting. • Thorough understanding of managed care payment methodologies and the principles of managed care. • Certification in Epic PB Resolute - or agree to obtain certification within 12 months after hire • Bachelor's Degree or equivalent combination of education and experience.

🏖️ Benefícios

• All employees are eligible for medical coverage on their first day! • Upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. • Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. • Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans.