Penn Highlands Healthcare

  • Billing Specialist, Physician Network

    Job Location US-PA-DuBois
    Posted Date 5 days ago(10/11/2018 11:26 AM)
    Job ID
    2018-11759
    # of Openings
    1
    Hours/Pay
    80
    Department
    Physician Network
    Shift
    1st Shift/Variable Hours
    Type
    Full Time
  • Overview

    The best of modern health care technology, plus the best of small town America!

    Located in the midst of the beautiful rolling hills and woodlands of Pennsylvania, you don't have to be a native to feel at home here. No matter where your roots, you'll quickly recognize that the staff at DuBois Regional Medical Center (DRMC), like other residents of the community, will make you feel right at home.

     

    DuBois Regional Medical Center (DRMC) offers residents of west central Pennsylvania a rare combination of technologically advanced health care in a warm, friendly environment. Widely recognized as one of the leading health centers of its kind in the commonwealth, DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. Its rural setting is just far enough from the hustle of the city life to make it peaceful, but close enough to provide easy access to sought-after urban attractions.



    THE BILLING SPECIALIST IS RESPONSIBLE FOR BILLING AND COLLECTING PATIENT ACCOUNTS RECEIVABLE BALANCES FROM THE INSURANCE COMPANIES IN A PROMPT AND EFFICIENT MANNER. THIS POSITION REQUIRES AN EXPERT IN DETERMINING THE OPTIMAL COMBINATION OF RE-BILLING, COLLECTIONS, AND REQUIRED PAYMENT FOLLOW UP ACTIVITIES. THIS POSITION PROVIDES PERTINENT AND TIMELY EDUCATION TO MEDICAL PRACTICE OFFICE STAFF TO ASSURE ACCURATE CLAIMS SUBMISSION. INTERPRETS ALL CONTRACTS AND DETERMINES THE CORRECT AND TIMELY PAYMENT. ENSURES THE WORKFLOW OF THE BILLING DEPARTMENT RUNS SMOOTHLY.

    Responsibilities

    *Complies with PENN HIGHLANDS DUBOIS policies and procedures, accreditation agency requirements, and federal, state or local law and regulations

    •  Submits insurance claims to third party payers for services received.
    • Investigates accounts receivable. Investigations include a systematic follow-thru, including written requests, oral communications, or other information until payment is received.
    • Reviews account information for accuracy, ability to identify correct procedure/diagnosis codes on services, initiates corrections and follow ups with appropriate office staff and/or physicians.
    • Verifies insurance coverage. Obtains effective date of coverage, deductibles, percentage of coverage, extent of non-covered services including second opinions, pre-certifications and authorizations, etc.
    • Monitors and responds to reports and statistical information as requested {i.e. days in A/R, failed claims, claims generated, failed billing requirements, end of day, month, year.}
    • Calculates allowances and adjustments based upon payor guidelines then posts to appropriate account/service. Prepares write-offs, refund requests and collections after proper investigation. Provides supporting documentation. Sends collections to agency when appropriate.
    • Assists patients with insurance claims and acts as advocate to help patient apply for Medicaid and/or charity care programs. Presents patients with account information and explains details. Posts insurance and/or direct patient payments to patient accounts, prepares daily bank deposits, and sends out monthly statements.
    • Reviews department detail charge logs and corrects errors as necessary combined with using this information as education for staff
    • Assists with special projects and suggests improvements for productivity, efficiency, and effectiveness. Educates office staff in order to create a seamless billing process.
    • Communicates insurance changes to staff such as changes to medical policy and no longer accepting a specific insurance carrier.
    • Other duties as assigned.

    Qualifications

    ·         High School Degree or Equivalent required.

    ·         Associate Degree in Business Administration or Coding Certification, preferred

    ·         At least 2 years of related Healthcare Billing experience, preferred.

    ·         Knowledge of Third Party Payer and Coding Quidelines.

    ·         Ability to Understand Insurance Terms, Medical Terminology, Medical Records, Coding, and Hospital Bills

    • Must have Computer Skills in Microsoft Office with Emphasis in Excel.

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