Billing Specialist

SUMMARY :

Under general supervision of the Billing Manager, performs insurance / billing clerical duties, including review and verification of patient account information against insurance program specifications.May resolve routine patient billing inquiries and problems follow up on balances due from insurance companies, and type invoices to insurance companies.May enter data electronically to process charges, payments, denials and adjustments.May analyze surgical procedures and diagnosis using ICD-9 &CPT-4 codes.Responsible for compliance related to third party billing; analyzes and resolves medical necessity issues.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include :

Instill Trust and Value Differences

Patient and Community Focus and Collaborate

RESPONSIBILITIES :

Review federal and state documentation for changes in billing regulations. Perform posting and / or reconciliation of numerical data or departmental and / or hospital accounting records. May process patient bills to various insurance companies and social welfare programs according to established billing procedures. Review patient accounting records and documents to verify accuracy of charges and third party information and initiate corrections. May calculate bills manually using detail bills.

Performs insurance billing duties / enter / edit / view claims in system, including review and verification of patient account information against insurance program specifications. Ability to identify source of entry in complex multi facility organization.

Analyze and resolve problems with coding of surgical procedures and diagnosis using ICD-9, CPT-4 and HCPC coding.

Effective interpersonal and communication skills required. Self-driven, results oriented with positive outlook. Ability to develop and maintain effective working relationships with staff.

Act as liaison and attend meetings with both internal and external departments when necessary to perform duties and aid in organization development.

Maintain productivity measures and accuracy standards defined by department.

Review reports, charts, records and / or bills that were prepared or assembled by others in order to ensure that calculations are correct. Contact other departments or personnel as necessary to resolve errors and omissions.

May download bills from mainframe system to claims editing system; translate claims, submit electronic and paper billing daily. Utilize variety of system necessary to resolve problems.

Participate in educational programs and in-service meetings.

May operate one or more standard and / or automated office machinery such as on-line computer terminal, calculator, fax machine, photocopier, and microfilm viewer.

May participate in training of new employees.

Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures and objectives.

Perform other related duties as required.

MINIMUM QUALIFICATIONS :

BASIC KNOWLEDGE :

High School diploma with proficiency in use of MS Office 2000 or later, particularly Excel and Word.

EXPERIENCE :

One - two years' experience in health care / patient accounting or relevant setting; or equivalent combination of training and relevant work experience.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS :

Work is performed in a typical office setting requiring sitting in a normal seated position for extended periods of time; reaching by extending hand or arm in any direction; and finger dexterity to manipulate keyboard. Position requires ability to speak, see and hear within normal range.

Brown University Health is committed to providing a flexible on-site and remote work schedule. The Billing Specialist is required to work 40 hours per week. A minimum of 8 hours on-site and up to 32 via telecommute. Telecommute Workdays will be determined by the Department Manager and are subject to change.

While telecommuting the Billing Specialist is required to have dedicated home office space and adhere to Brown University Healths Protected Health Information and Policies.

INDEPENDENT ACTION :

Incumbent functions independently within department policies and procedures; generally referring specific problems to supervisor only where clarification of departmental policies and procedures may be required. Must be able to maintain productivity measures and accuracy standards defined by department.

SUPERVISORY RESPONSIBILITY :

None.

Pay Range : $19.58-$32.31

EEO Statement :

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location :

Corporate Headquarters - 167 Point Street Providence, Rhode Island 02903

Work Type : 7 : 30AM-4 : 00PM

Work Shift : Day

Daily Hours : 8 hours

Driving Required : No