Overview
Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurance
follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge
of UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle
denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business
office responsibilities related to patient accounts, including charge import, diagnostics and procedural coding,
and claim follow-up with third-party payers to achieve a zero-balance resolution.
Special InstructionsThis position has to possibility of being remote after 6 months, per managers discretionResponsibilities
Promote the mission, vision, and values of the organization
Import charges from queues in a timely manner and append modifiers or any required
information for claim transmission
Review daily accounts that are ready to be billed in Waystar from Meditech
Initiate correction on all claims with errors by the designated time
Follow up on any correspondence that may have been received on that day or the
previous day
Cross train on billing all lines of business to the different payers
Pull listing of all accounts assigned to be follow up by specific payer
Diagnostic and procedural coding
Follow-Up Responsibilities
Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and
policies.
Communicate with third-party representatives as necessary to complete claims processing and /or resolve
problem claims.
Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and
rebilling, and denied claims for accounts.
Maintain accounts receivable detail of their accounts through tasking.
Maintains standards per payer for percentage accounts >90 days.
Works minimum standard number of accounts per payer per day.
Meets or exceeds collection goals by payer each month.
Works all assigned accounts as assigned, depending on balance.
Participates in educational activities and attends monthly department staff meetings.
Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
Other duties as assigned from time to time.
Attend educational activities and monthly department staff meetings
Perform other duties as assigned
Qualifications
Education
High School Diploma or GED
Minimum Work Experience
Six months previous experience in hospital registration, billing and collections, financial counseling, or customer service preferred
Required Skills, Knowledge, and Abilities
Knowledge of medical terminology preferred Basic computer proficiency Typing speed: minimum 40 WPM Familiarity with CPT and ICD-9 coding is helpful Good written and verbal communication skills are essential for account follow-up
Employment Type: OTHER