Remote within 4 hour drive to Wooster - Lead Insurance Billing Specialist

MAIN FUNCTION:

Follow-up on submitted claims for payment. Coordinates with Registration Department and Case Management Department for approvals, denials and changes in billing requirements. Handles inquiries on patient accounts regarding insurance billing and accounts receivable. Follow up on Credit balances and Charging or Cash Posting Payments and adjustment errors. Serves in a consultative role for other insurance billing specialists. Provides feedback on team member performance to Manager and Director. Participates in hiring process for Insurance Billing Specialist team members by interviewing with, and providing feedback to manager for candidates.

RESPONSIBLE TO: System Manager, Revenue Cycle

MUST HAVE REQUIREMENTS:

High School Diploma or GED.

5 years current billing experience, preferably in a hospital setting.

Strong Microsoft application skills, including Excel

Strong organizational skills.

No written disciplinary action within the last 12 months.

PREFERRED ATTRIBUTES:

Prior management/leadership role experience

Demonstrated effective oral communication skills.

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  Denotes ADA Essential

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  Follows Appropriate Service Standards

POSITION EXPECTATIONS:

• Reviews all rejected/denied claims in assigned work queues. Investigates denial/rejection reasons and resubmits claims as appropriate. Ensures that all accounts have complete collection notes so as to ensure steps taken to collect are documented. Escalates unpaid claims for review to department leadership as necessary.

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  Reviews aged accounts receivables and follows up with necessary action to obtain payment from third party payers

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  Attaches any necessary reports or forms to claims when applicable.

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  Monitors claims and remits for any trends in denials/rejections and reports trends to leadership for review as necessary with payer representatives.

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  Makes transfers and adjustments to patient accounts to ensure accuracy of statements.

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  Communicates issues/concerns with processes that involve other departments, such as Registration to department leadership so they can be shared with the appropriate Department Directors

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  Conducts research into AR inventory for trends in unpaid claims as requested

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  Assists Manager in keeping the insurance plan dictionary in computer system up to date.

Revised Dates: 2/23

Approved by Human Resources: