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Cheyenne Regional Medical Center · 21 hours ago

CRMG Billing Specialist

Cheyenne, Wyoming, United States

Full-time

Onsite

New Grad, Entry Level

0+ years exp

Cheyenne Regional Medical Center is the largest hospital in Wyoming, committed to providing excellent healthcare services. The CRMG Billing Specialist is responsible for ensuring timely and accurate patient account billing and payer reimbursement while providing outstanding customer service to both patients and payer sources.

Health CareHospitalMedical

Responsibilities

Pursues and participates in education for assigned payer to remain current with changes in the healthcare industry via payer websites, payer newsletters, webinar and attendance at assigned payer meetings

Reviews accounts each day in assigned Epic Work Queues and prioritize by dollar amount and timely filing rules to achieve the best possible reimbursement

Completes necessary research to submit claims to appropriate payer based on coordination of benefits and active coverage at time service was rendered

Evaluates payer remittance advice and/or explanation of benefits on denials for accuracy according to individual payer contracts

Maintains knowledge of Medicare, Medicaid, and all commercial insurance programs, including Medicare HMO’s and State Programs to include filing deadlines, billing requirements, and reimbursement methods

Composes and submits appeals to third party payers, appealing to the highest level to resolve account denial for proper reimbursement

Receives and researches patient, payer, attorney, and third party inquiries received through incoming calls and correspondence in a timely manner by reviewing all available information including payer remits, contracts, documentation, policies and procedures, and insurance laws to formulate an informative response and direct the account appropriately

Maintains or exceeds performance metrics according to job assignment focusing on reduction to Accounts Receivable Days and Denial Rates

Provides feedback to management on denial trends and claim edits to assist with process improvement and quality assurance within our billing software

Provides exemplary customer service and demonstrate positive communication skills in a courteous, accurate and honest manner

Performs intake responsibilities and obtains patient insurance benefits information ensuring pre-certifications, authorization and referral requirements are met prior to the delivery of home care services

Maintains current authorizations and manages work queues

Performs other duties as assigned by Home Care leadership

Qualification

BillingCoding knowledgeHIPAA complianceMedical terminologyCustomer service experienceBilling/Coding CertificationHealthcare billing experienceHome care billing experienceTyping speed 40 wpmMultitasking abilityCash handlingAttention to detail