Wellstar Health System · 1 day ago
Billing & Claims Spec 1 MGBO
Atlanta, GA
Full-time
Remote
Entry Level
1+ years exp
Maximize your interview chancesFitnessHealth Care
Insider Connection @Wellstar Health System
Get 3x more responses when you reach out via email instead of LinkedIn.
Responsibilities
Prepares and submits clean claims to third party payers either electronically or by paper.
Analyze, research, and independently resolve claim submission edits and payor rejections by obtaining information from the medical record and applying CMS rules and regulations, CPT coding guidelines, and departmental policies and procedures relative to claim submission.
Works with clearinghouse, Change Healthcare, including appropriate follow-up and with support issues.
Coordinate process of patient eligibility through various third-party sources.
Ensure all billing activity on accounts is documented and explained in the appropriate fields in the patient accounting system.
Identifies and resolves patient billing issues.
Denial and insurance follow-up management.
Attach documentation when required by payor for claim processing.
Consistently meet the current productivity and quality standards in processing daily electronic and/or paper claims to payers.
Issues adjusted, corrected and/or rebilled claims to third party payers.
Identify opportunities for system and process improvement.
Follow Joint Commission and outside regulatory agencies mandated rules and procedures.
Maintains strictest confidentiality, adheres to all HIPAA guidelines/regulations.
Follow the Wellstars general Policy and Procedures, the Departments Policy and Procedures, and the Emergency Preparedness Procedures.
Perform other duties and responsibilities as assigned.
Resolve payer rejections, ICN claim errors, resolve Master File errors, Retro Review (Visit Filing Order Updates), and any Transfer work queue assignments.
Add attachments and mail paper claims.
Resolve Miscellaneous work queue errors.
Review and override external edits from clearing house.
Complete Railroad Medicare Claim Submissions.
Maintain confidentiality in matters relating to patient/family.
Assure patient privacy and confidentiality as appropriate or required.
Ensure minors have a parent or guardian listed as guarantor as appropriate.
Interact with patients/families with a variety of developmental and sociocultural backgrounds.
Provide information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring.
Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.
Initiate communication with peers about changes and procedures.
Relay information appropriately over telephone, email, and other communication devices.
Interact with internal customers including HIM, Revenue Integrity, Patient Access, and Patient Financial Services in a professional manner to achieve revenue cycle department AR goals and objectives.
Assist with special projects as assigned.
Work closely with other staff, co-workers, peers, and other members of the healthcare team to ensure a positive and effective work environment.
Report to appropriate personnel regarding assignments, projects, etc.
Initiate problem solving and conflict resolution skills to foster effective work relationships with peers.
Report to work on time and as scheduled.
Attend staff meetings, in-services, and continuing education.
Assist in the development of indicators, thresholds, study methods, and data collection as assigned.
Respond to problems/opportunities to improve care/customer service.
Support involvement in system performance improvement initiatives.
Participate in and maintain competencies required for the position and specific unit/area(s) of assignment.
Qualification
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
High school diploma Equivalent Required
Certified Revenue Cycle Rep within 1 Year
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 required.
Works well with deadlines and is results oriented.
Good communication skills and customer service skills when interacting with patients, co-workers and physician practices.
Strong problem solving and analytical aptitude.
Excellent time management skills and capacity to work independently.
Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g. financial responsibility, safety, partnership and service, teamwork, compassion, integrity, trust and respect.)
Company
Wellstar Health System
The largest health system in Georgia.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Candice L. Saunders
President and CEO
B
Bill Bellando
Chief Technology Officer
Recent News
Company data provided by crunchbase
