Insurance Billing Specialist

WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION

Insurance Billing Specialist

MAIN FUNCTION:

Submits patient claims to their prospective payors, either electronic or hardcopy.   Follow-up on submitted claims for payment.  Collaborates with other departments to resolve outstanding claims.  Handles inquiries on patient accounts regarding insurance balances.  Follow up on credit balances, charging or cash posting payments and adjustment errors.  

RESPONSIBLE TO:      System Manager, Revenue Cycle

MUST HAVE REQUIREMENTS:

High School Diploma or GED.

Excellent problem solving skills

Basic Microsoft Office skills, including Excel

Ability to self-direct and manage time effectively.

Ability and willingness to learn new systems and processes.

Ability and willingness to adapt to changing departmental needs and priorities.

Strong organizational skills.

1 year current billing experience, preferably in a hospital setting.

No written disciplinary action within the last 12 months.

PREFERRED ATTRIBUTES:

Previous hospital billing experience to include follow up with all payer sources, computer and word processing experience.

Knowledge medical coding, including CPT, HCPC and diagnosis coding

Demonstrated effective oral communication skills.

All position expectations are ADA essential.

Follows Appropriate Service Standards

POSITION EXPECTATIONS:

Effectively collect and resolve third party patient accounts receivable by performing appropriate claims follow up, utilizing standard and compliant practices.

Provide customer service to internal and external customers to assist in claims resolution.

Develop and maintain knowledge and skills around payer reimbursement to ensure appropriate payment on claims.

Effective and efficient use of payer portals and other online resources to resolve outstanding claims.

Other duties as assigned by leadership.

Revised Dates:  5/99, 2/00, 3/02, 7/03, 8/03, 3/04, 3/05, 4/10, 11/10, 4/11,5/18, 2/20, 11/23

Approved by Human Resources