Columbia Valley Community Health · 3 weeks ago
Insurance Billing Specialist I or II
Wenatchee, Washington, United States
Full-time
Onsite
Mid Level
$21.06/hr - $30.27/hr
3+ years expColumbia Valley Community Health is seeking an Insurance Billing Specialist I or II to manage and process insurance claims efficiently. The role involves following up on unresolved claims, ensuring accurate billing, and maintaining auditable records while building positive relationships with payers and clinical staff.
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Responsibilities
Via electronic work lists, user generated reports or as directed by management, follows up on unresolved claims in a timely fashion. Includes claims with no response, pended or denied
Identifies rejected claims files, researches reject reason(s) and resolves affected claims errors. Resubmits files as needed to ensure receipt of clean claims
Assists system vendor with appeal requests, or processes appeals directly with payer for denied claims as dictated by department policy
When claims are denied for coding related reasons, effectively utilizes coding software and/or books to confirm coding accuracy in order to resolve claims with the payer. May seek assistance from clinic coders
Ensures claims have correct insurance information and are billed to insurances timely
Prepares and finalizes insurance claims for batch processing and submission to system vendor, clearinghouse or direct to payer
Ensures insurance coverage records are complete and accurate for patient accounts. Verifies insurance coverage via electronic means or by phone when required. Makes corrections as needed
Contacts patients or insured members to resolve insurance coverage discrepancies
Confirms receipt of batch claims by insurance, system vendor or clearinghouse via electronic means or by phone. Monitors files for acceptance by same as dictated by department policy (normally within 48 hours)
Processes secondary and tertiary insurance claims, electronically or via paper, as dictated by department and payer policy
Receives and posts electronic or manual insurance payments and adjustments in a timely fashion
Resolves unidentified or problem payments according to department policy. Is sure to balance payments posted with remittance or EOB prior to completion
Receives, researches and processes insurance and patient correspondence
Processes adjustments and requests approval for write-off of balances as dictated by department policy
Is careful to use correct adjustment or payment codes for processing and reporting needs
Understands, utilizes and properly posts industry standard claims and remittance codes (CARC and RARC)
Communicates with accounting department, via spreadsheets, regarding processed or pending payments for cash reconciliation purposes
Thoroughly researches insurance credit balances and processes adjustments or refunds as needed and dictated by department policy
Identifies trends in causes of credit balances as works with the appropriate CVCH departments (Patient Services, Billing, etc.) to prevent credit balances
Is responsible to remain current with general billing guidelines, reimbursement rules and regulations
For assigned payers, is responsible to remain current with their specific guidelines by reading payer publications and reviewing their websites
Understands FQHC billing nuances to ensure accurate coding and maximum reimbursement for related services
Attends conferences, seminars and webinars as requested to remain current on billing related policies
Maintains accurate, complete and auditable billing records in accordance with CVCH policy and procedures
Appropriately and thoroughly documents patient accounts and/or claims with each action taken and each contact made to resolve the claim or account balance
Scans appropriate documents for electronic storage purposes, according to department policy
Builds and maintains positive relationships with payers, clinical department staff, corporate compliance, etc
Participates with claims resolution meetings, projects or problem-solving processes for assigned payers
Utilizing approved methods, communicates incorrect application of insurance coverage or benefits with clinic department staff members. Meets with clinical departments as needed or requested to provide updates regarding insurance coverage or benefit application concerns
Participates with educational activities with clinical departments, corporate compliance, etc. to ensure lines of communication among departments remains open and positive
Assists providers, staff and insurance payer representatives with insurance and billing inquiries in a friendly and professional manner
Completes and follows up on credentialing and re-credentialing of providers with appropriate insurance companies
Provides information as needed for production reporting and to ensure job standards are consistently met or exceeded
Assists with internal audits by providing requested information and participating in review finding discussions regarding insurance processing performance. Submits to remedial training if substandard performance is identified through such audits
Assists co-workers and management with special projects related to claims or A/R clean-up efforts
To ensure uninterrupted service, participates in cross-training efforts and provides coverage for insurance processing and follow-up needs with non-assigned payers
Actively participates in departmental and/or organizational process improvement (lean) initiatives
Notifies management of audit requests by insurance payers and complies with requests in a timely manner
Performs other duties as assigned by management
Engages in training Patient Services and Call Center Agent’s to meet organizational needs
Performs complex holds to resolve denials and performs higher level tasks
Qualification
Required
High School graduate or equivalent
3 years billing experience in a healthcare setting preferred
Strongly prefer knowledge of diagnosis and procedural coding, medical terminology and insurance billing guidelines
Fluent with industry X12 and ANSI guidelines
Proficient with claims adjustment reason and remark codes (CARC and RARC)
FQHC certification or billing experience
English required
Knowledge of computer applications and equipment related to work
Basic computer and keyboarding skills
Ability to enter data within company's computer system
Strong knowledge in MS Word/Excel
Demonstrate manual dexterity
Exhibit strong customer service skills
Strong process improvement background
Strong interpersonal and communication skills
Ability to work effectively with other staff and management
Demonstrated skill in developing and maintaining productive work teams
Ability to demonstrate personal integrity in all interactions
Ability to make decisions in line with state and federal regulations
Ability to read, comprehend, and analyze documents, regulations, and policies
Ability to prepare and submit complete and succinct documents necessary to the job
Ability to assess and evaluate, have attention to detail
Knowledge of auditing and compliance procedures
Knowledge of quality assurance and improvement practices
Understanding of the elements of sponsored clinical protocols including consent forms, and reporting requirements
Problem solving and analytical skills are required with a heavy emphasis on detailed analysis of information to support actions
Ability to read computer keyboard, monitor, and documents
Prepare and analyze documents
Read extensively
See, recognize, receive and convey detailed information orally, by telephone and in person
Convey accurate and detailed instructions by speaking to others in person and by telephone
Benefits
Medical
Dental
Paid Leave
Extended Illness Bank (EIB)
Holidays
403(b) Retirement Plan
Employee Assistance Program
Long-term Disability
Basic Term Life
Group Accidental Death and Dismemberment (AD&D)
Supplemental Term Life
Voluntary AD&D
Health Reimbursement Arrangement
Flex Plan: Medical
Flex Plan: Dependent Care
AFLAC
Wellness Stipend
Cell Phone Discounts
Tuition Reimbursement
Company
Columbia Valley Community Health
Columbia Valley Community Health is a medical hospital.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Manuel Navarro
Chief Executive Officer
Felipe Gutierrez
Chief Medical Officer
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