SGMC Health · 12 hours ago
INSURANCE BILLING SPECIALIST, PATIENT FINANCIAL SERVICES
Valdosta, GA
Full-time
Onsite
New Grad, Entry LevelSGMC Health is committed to providing exceptional care to the community. The Insurance Billing Specialist will be responsible for processing billing requests, verifying insurance coverage, and ensuring timely collection of payments for hospital charges.
Health CareHospitalMedical
Responsibilities
Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned
Verifying patients’ insurance coverage
Answering billing questions from internal and external customers
Responsible for the timely billing, correction of edits, follow up of unpaid balances, and appealing of denials of hospital charges
Verifying patient’s insurance coverage and benefits
Answering billing questions from internal and external sources
Responsible for subset of payers and/or alpha split of payer groupings
Will be accountable for the overall health of the accounts receivables assigned
Responsible for daily review of correspondence, outstanding insurance credit balances, over-posted account balances, and paid claims with outstanding balances
Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system
Submits claims in Epic HB Resolute Billing system
Documents and updates status of unpaid insurance balances
Researches and analyzes various billing reference manuals to review billing accuracy
Documents electronic system regarding returned faxes and Certified Return Receipts
Completes production logs
Processes outgoing mail
Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems
Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, Medicare, Medicaid, and other payer web portals, Craneware, Microsoft Office applications, and Experian claim source clearinghouse portal
Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach State; Wellcare; CareSource, Amerigroup; Tricare (Standard, Extra and Prime); VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing
Working knowledge of CPT-4, HCPCS, and ICD-10
Knowledgeable of insurance and reimbursement process
Must have a thorough understanding and knowledge of: patient type; financial class; insurance master; place of service codes;; relationship codes; accommodation, occurrence, value and condition codes
Related regulatory and legal requirements: Medicare Secondary Payer Questions; medical necessity; Medical Reviews and Appeals
Interacts with: patients; other departments; insurance companies; employers; intermediaries; utilization review companies; state regulatory agencies (GMCF, Medicaid); and attorneys
Knowledge of medical terminology
Strong verbal/written communication skills, highly organized with the ability to prioritize work
Able to communicate effectively with a wide range of individuals
Substantive communication required with physicians, insurance companies, customers and staff
Must be highly organized and self-motivated, requiring little or no supervision to carry out duties
Ability to prioritize and execute multiple tasks to accomplish timely and effective resolution of patient accounts
Working knowledge of medical terminology, revenue, CPT and ICD-10 codes, and 1500 forms
Ability to review and completely understand an EOB, recognize problems, and communicate payer denial trends to supervisor which prohibit payment from insurance carriers
Ability to maintain acceptable levels of productivity with minimal errors. Requirement is 60 accounts minimum per day once training is completed
Strong analytical, interpersonal and communication skills required
Excellent PC and data entry skills essential
Familiarity with HIPAA privacy requirements for patient information
Excellent customer service skills
CPAR certification highly desirable
Qualification
Required
Prior hospital billing experience recommended
Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system
Submits claims in Epic HB Resolute Billing system
Documents and updates status of unpaid insurance balances
Researches and analyzes various billing reference manuals to review billing accuracy
Documents electronic system regarding returned faxes and Certified Return Receipts. Completes production logs. Processes outgoing mail
Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems
Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, Medicare, Medicaid, and other payer web portals, Craneware, Microsoft Office applications, and Experian claim source clearinghouse portal
Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach State; Wellcare; CareSource, Amerigroup; Tricare (Standard, Extra and Prime); VA; Disability Adjudication Services; Vocational Rehabilitation; Children's Medical Services; Cancer State Aid; Crime Victim's Compensation Program; Knight's Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker's Compensation; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing
Working knowledge of CPT-4, HCPCS, and ICD-10
Knowledgeable of insurance and reimbursement process
Must have a thorough understanding and knowledge of: patient type; financial class; insurance master; place of service codes; relationship codes; accommodation, occurrence, value and condition codes
Related regulatory and legal requirements: Medicare Secondary Payer Questions; medical necessity; Medical Reviews and Appeals
Interacts with: patients; other departments; insurance companies; employers; intermediaries; utilization review companies; state regulatory agencies (GMCF, Medicaid); and attorneys
Knowledge of medical terminology. Strong verbal/written communication skills, highly organized with the ability to prioritize work
Able to communicate effectively with a wide range of individuals. Substantive communication required with physicians, insurance companies, customers and staff. Must be highly organized and self-motivated, requiring little or no supervision to carry out duties. Ability to prioritize and execute multiple tasks to accomplish timely and effective resolution of patient accounts
Working knowledge of medical terminology, revenue, CPT and ICD-10 codes, and 1500 forms
Ability to review and completely understand an EOB, recognize problems, and communicate payer denial trends to supervisor which prohibit payment from insurance carriers
Ability to maintain acceptable levels of productivity with minimal errors. Requirement is 60 accounts minimum per day once training is completed
Strong analytical, interpersonal and communication skills required
Excellent PC and data entry skills essential
Familiarity with HIPAA privacy requirements for patient information
Excellent customer service skills
Preferred
CPAR certification highly desirable
Benefits
Low Healthcare Insurance Premiums
401(k) with employer match
Paid Time Off (PTO)
Employee discounts
Company paid life insurance
Short-Term and Long-Term Disability
Cancer Insurance
Accident Insurance
Pet Insurance
Tuition Reimbursement
On-the-job training and skills development
Opportunities for growth and advancement
Employee Assistance Program
Company
SGMC Health
SGMC Health is the most comprehensive health system serving South Georgia and North Florida.
Founded in 1955
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ronald E. Dean, MBA, FACHE
President and Chief Executive Officer
John Moore
Senior Vice President and Chief Financial Officer
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