Memorial Healthcare System · 1 hour ago
Billing Specialist I - FT - Days - MSS - Hybrid Eligible
Memorial Support Services
Full-time
Hybrid
New Grad, Entry Level
0+ years expMemorial Healthcare System is dedicated to improving the health and quality of life for the people entrusted to their care. The Billing Specialist is responsible for resolving claim edits for payors and ensuring compliant billing based on various regulations and guidelines.
Health Care
Responsibilities
Reviews coding to ensure that the procedures coded are billable according to the regulations set by the different payors
Adds applicable billing modifiers, when needed
Resolves clearinghouse errors and resubmits the claim for processing
Bills secondary or tertiary insurance by interpreting the explanation of benefits (EOB) from the payor
Adjusts or bills late charge/credit replacement claims using insurance payment methodologies
Resolves claims edits monthly for skilled nursing/long term care for accurate and timely submission of paper and/or electronic claims.- for Hospital billing
Documents all billing activities in patient account record to accurately reflect what changes have been made to the claim/or insurance information
Identifies billing errors trends and directs these trends to management for review and/or resolution
Confirms and corrects patient insurance information by calling the guarantor and/or mail inquires for accident insurance, workman's comp, or other needed insurance information
Updates account with any discovered insurance and notates the account with the new insurance information
Applies the unsolicited 271 transaction to add the insurance to the account, when applicable
Creates and submits Part B only claim to Medicare for inpatient services when Medicare Part A benefits are exhausted
Works in appropriate claim system for Medicare and Medicaid to resolve overpayments by the payor by updating claim information in their system. - for Hospital billing
Resolves edits in charge review/charge router work queues to ensure complaint billing based on medical documentation - for Physician Billing
Resolves error in claim edit work queues for accurate and timely submission of paper and/or electronic claims
Uses OIG, CMS and HIPPA guidelines to refer a claim to the appropriate department for review and resolution of the errors, as needed
Resolves payor gateway rejections using payor systems (EDI) information and analysis of the claim issue - for Hospital billing
Requests and submits appropriate medical records to selected insurance companies or Medicare either for initial billing requirements or to respond to Additional Documentation
Requests (ADR) for oncology services
Works with audit nurses on coordination of medical records and letter of medical necessity for a formal appeal.- for Hospital billing
Enters all Recovery Audit Contractor (RAC) reviews into the third-party software
Requests medical records and coordinates the response to the RAC request.- for Hospital billing
Qualification
Required
High School Diploma or Equivalent (Required)
Knowledge of UB–04 and/or CMS 1500 form, billing guidelines, insurance contract and payment methodologies
Excellent communication skills
Critical thinking skills
Decisive judgment
Ability to work with minimal supervision
Ability to work in a stressful environment and take appropriate action
Preferred
Knowledge of UB-04 and EPIC hospital billing experience preferred
Knowledge of CMS 1500 and EPIC professional billing experience preferred
Company
Memorial Healthcare System
Be at the heart of exceptional care.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Paul Gaden
Chief Executive Officer, Memorial Regional Hospital
Rita Bunch
Chief Operating Officer, Memorial Regional Hospital
Recent News
2025-02-06
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