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Phelps County Regional Medical Center Billing Specialist I in Rolla, Missouri

General Summary

  • The Billing Specialist I is responsible for collecting and entering claims, post insurance, submit claims, and answer patient inquiries on accounts. Reports to the Billing Supervisor.

Essential Duties and Responsibilities

  • Enters information necessary for insurance claims such as patient, insurance, and insurance ID. Insures claim information in complete and accurate.

  • Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.

  • Answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc. resolves patient's complaints or explains why certain services are not covered.

  • Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims.

  • Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.

  • Work with patient to establish payment plan for past due accounts in accordance with provider policies, as needed.

  • Follows HIPAA guidelines in handling patient information.

  • Provides necessary information as needed to collection agencies for delinquent or past due accounts.

  • Post insurance and patient payments using medical claim billing software.

  • May perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.

  • Prepares and submits secondary claims upon processing by primary insurer.

  • Understand managed care authorizations and limits to coverage such as number of visits.

  • Verify patient benefits eligibility and coverage as needed.

  • Look up ICD10 diagnosis and CPT treatment codes from online service or using traditional coding references.

Job Qualifications

  • Education

  • High School Diploma or GED required.

  • Work Experience

  • Medical billing experience highly preferred. Experience in billing software and electronic data submission preferred.

Mental/Physical Requirements

  • Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds. .

Working Conditions

  • Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.
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