• Job Description

  Req#: JR102784

  CURRENT HOLLAND HOSPITAL EMPLOYEES- Please apply through Find Jobs from your Workday employee account.

  Job Type: Full Time, 80 hours every two weeks

  Shift: Mon-Fri

  Weekend Frequency: No weekends or holidays

  Wage Range: $15.72-$23.21

  Education Requirements:

  - High school diploma/GED or higher education

  Insurance Billing Specialist

  • Provide exemplary customer service.
  • Works daily electronic billing system (Cerner & nThrive) and submits insurance claims to third-party payers; reviews daily claim edits from the hospital billing system and makes necessary corrections to allow electronic submission.
  • Assessing and analyzing claim edits daily within the billing system leading to a resolution within 24-48 hours.
  • Maintains a thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries in order to promote compliant claims submission practices for governmental claims.
  • Communicates any edits that may need joint resolution with external departments.
  • Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
  • Resubmission of claims that may need corrections.
  • Verify that claims have been received by the appropriate payer.
  • Investigate and resolve any issues in regards to claim transmission.
  • Mail/Fax/Email paper claims to the appropriate payer the day they are generated.
  • Performs effective, timely and efficient follow-up on all outstanding debit and credit balances within the expected time period.
  • Review and analyze outstanding debit and credit balances to determine appropriate follow-up.
  • Contributes innovatively to the success of our department and is compliant in all patient and billing aspects.
  • Maintains a base-line understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits to ensure compliance.
  • Effectively handles communications, including email, telephone and instant message, from payers and departments within and outside of the department.
  • Understands and maintains compliance with HIPAA guidelines when handling patient information.
  • Reviews, processes, and resolves all incoming patient and insurance correspondence within one business day.
  • Reviews and prepares responses to correspondence from patients and insurance carriers within a reasonable time frame.
  • Responds to formal communication, both external and internal, within a reasonable time frame.
  • Documents all activity taken within an encounter in the billing system.
  • Clear and concise messaging.
  • Responsible for making and documenting timely phone calls to insurance in regards to billing matters within the billing system.
  • Provides updates to existing policies and procedures as needed and proposes new.
  • Communicates with staff routinely and effectively using all forms of communication.
  • Builds relationships and fosters positive communication with applicable departments outside of PFS.
  • Documents all activity - each time an account is touched - in the notes section of the AR Host I.S. System, at the account level, appropriately, timely, compliantly and thoroughly.
  • Stays current on healthcare regulations.
  • Attends training sessions, internal and external.
  • Performs other related duties as assigned.

  Holland Hospital is an Equal Opportunity Employer, please see our EEO policy

• About the company

  Holland Hospital is a non-profit hospital located in the West Michigan lakeshore area.

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