Biller Denial Management Specialist

POSITION SUMMARY

The position bills claims to HMO’s, Blue Cross Plans, Medical Assistance, and Medicare using standard hospital UB04’s and 1500 forms through electronic claim transmission and paper in HIPPA compliant format. Reviews registrations for complete information obtained by registration to ensure accurate billing.  Reviews all claims for accurate departmental charges before billing.  Contacts insurance companies by telephone and internet for up to date billing procedures.  Contacts physician’s offices by telephone for billing information.  Performs a variety of duties relating to interfacing with insurance professionals (Hospital Insurance Provider Representatives) and other departments within the Medical Center. Performs a variety of duties relating to the processing of data for billing purposes.

MINIMUM REQUIREMENTS

Education:

1. High School graduate or equivalent.
2. Graduate of an approved medical secretarial Associate Degree program preferred and / or minimum of 2 years of related experience.

Experience:

1. Relevant experience in a related position which has provided the applicant with strong working knowledge in HIPPA compliance coding and billing.

Knowledge, Skills, Abilities:

1. Demonstrating knowledge in HIPPA compliant ICD-10 CM Diagnosis and procedure codes, CPT-4 codes, billing HIPPA compliant claims electronically on standard hospital forms or (alternatively).
2. Must have working knowledge and proficiency in computer operation.
3. This individual must be able to work as a team member with job sharing. Good communication skills to initiate communication to Mount Nittany Health System staff and insurance professionals regarding charges, coding and diagnosis problems.
4. Must have an understanding of the UB04 and / or 1500 forms and the procedure for review of CPT – 4 codes, combined batteries, HIV charges requirements to release information, and review of revenue codes for HCPCS entered by Medical Records following HIPPA compliant formatting.
5. Possess thorough knowledge of claims submission process.
6. Must have knowledge of the assigned third parties' billing requirements
   1. Medicare
   2. Medicaid
   3. Blue Cross
   4. Commercial
   5. HMO
   6. MVA
   7. OVR
   8. MH/MR
   9. Worker's Compensation
7. Knowledge of specific medical and Health System billing applications, i.e., Medicare, Medical Assistance, Blue Cross Plans and HMO’s is preferred.

License/Certification/Registration:

1. None required.

SUPERVISION RECEIVED

Receives general supervision from the Supervisor, Patient Billing.

SUPERVISION GIVEN

None.