Billing and Claims Specialist

🔥 17 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Wellstar Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1992

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Wellstar Health System is a comprehensive healthcare organization dedicated to providing personalized and compassionate care to patients in Georgia and South Carolina. With a diverse range of career opportunities, Wellstar supports its employees' career growth and wellbeing through a positive culture, excellent benefits, and a focus on diversity, equity, and inclusion. The organization emphasizes the importance of treating both patients and staff with respect and care, making it a sought-after workplace in the healthcare industry. Wellstar is committed to offering high-quality healthcare services and maintaining strong community engagement.

📋 Description

• Prepare and submit clean electronic and paper claims to third-party payers • Analyze, research, and independently resolve claim submission edits and payer rejections • Obtain information from medical records and apply CMS rules, CPT coding guidelines, and departmental procedures • Follow up with clearinghouse Change Healthcare and address support issues • Coordinate patient eligibility processes through third-party sources • Document and explain billing activity in the patient accounting system • Identify and resolve patient billing issues and manage denial and insurance follow-up • Attach payer-required documentation and mail paper claims • Issue adjusted, corrected, and rebilled claims • Resolve payer rejections, ICN claim errors, Master File errors, retro-review issues, transfer work queues, and miscellaneous work queue errors • Review and override external clearinghouse edits • Complete Railroad Medicare claim submissions • Identify opportunities for system and process improvement • Maintain patient confidentiality and privacy in accordance with HIPAA • Communicate professionally with patients, families, peers, healthcare teams, HIM, Revenue Integrity, Patient Access, Patient Financial Services, and referral agencies • Attend staff meetings, in-services, and continuing education • Assist with special projects and performance improvement initiatives • Maintain required competencies and comply with Wellstar policies, standards of work, and code of conduct

🎯 Requirements

• High School Diploma / GED • Minimum 1 year medical billing experience, including knowledge of billing related reporting • Experience working with medical payers including Medicare, Medicaid, and commercial insurance • Working knowledge of CPT and ICD-10 coding systems • Knowledge of medical billing and collection practices • Ability to meet deadlines and be results oriented • Good communication and customer service skills • Strong problem solving and analytical aptitude • Excellent time management skills and capacity to work independently • Knowledge of HIPAA guidelines/regulations • Ability to follow CMS rules and regulations, CPT coding guidelines, departmental policies and procedures, and regulatory requirements • Ability to maintain confidentiality and patient privacy • Ability to interact with patients/families with varied developmental and sociocultural backgrounds • Ability to use telephone, email, and other communication devices • Ability to work with Epic EMR, external claim scrubber edits, clearinghouse systems, and patient accounting systems • Ability to perform claims work involving Medicare, Medicaid, commercial insurance, and Railroad Medicare

🏖️ Benefits

• Support to do more meaningful work • More rewarding life • Staff meetings, in-services, and continuing education • Participation in system performance improvement initiatives • Supportive work environment • Full-time employment