Position Summary: 

The Insurance Billing Specialist’s main focus is to obtain maximum and appropriate reimbursement for Bozeman Health and all related entities,  hospital (HB) and/or professional (PB) claims from third party payers.  Supports the timely development and accurate submission of claims to third party payers to include insurance follow-up related to no response, returned claims, denied claims, or claim edits preventing claim submission, submitting corrected or replacement claims, and combining hospital accounts in accordance with payer billing policies.   Monitor, resolve or escalate payer denials, returned claims, claim edits, correspondence and report payer claim processing behavior to assist with identifying systemic issues that may require process improvement to strengthen the health of the Revenue Cycle as well escalating identified concerns to the HB or PB Supervisor.   Collaborate and coordinate with other Revenue Cycle functions or departments to resolve DNBs, claim edits, denials that are preventing  timely claim submission or appropriate reimbursement.  Prioritizes and completes accounts routed to billing WQs to reduce accounts receivable days and escalates high-dollar accounts or systemic issues to either the HB or PB Billing supervisor for resolution.   

Minimum Qualifications:

• High School Diploma or Equivalent
• One (1) year of general or medical office experience
• Preferred: Epic experience
• Preferred: Completion of program in medical billing degree or certification program
• Preferred: Two (2) years of healthcare hospital and/or professional billing experience

Essential Job Functions:

• Submits timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission
• Follows up on applicable No Response WQs and Rejected Claims WQs through phone contact or written correspondence to ensure that no account reaches 180 days old from discharge date and still due by insurance, regardless of dollar amount
• Reviews accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and submitting adjustments for approval when necessary, routes claims for appeal, resubmits claims, or moves balances from insurance responsibility to patient responsibility when appropriate
• Ensures that claims have appropriate information on them for submission to insurance companies or agencies by reviewing claim edit WQs and other prebilling insurance WQs and escalates systemic issues identified to supervisor
• Assists Customer Service with claim processing questions
• Identifies and escalates concerns regarding claim processing to Billing Supervisor

Knowledge, Skills and Abilities

• Demonstrates sound judgment, patience, and maintains a professional demeanor at all times
• Exercises tact, discretion, sensitivity, and maintains confidentiality
• Performs essential job functions successfully in a busy and stressful environment
• Learns current and new computer applications and office equipment utilized at Bozeman Health
• Strong interpersonal, verbal, and written communication skills
• Analyzes, organizes, and prioritizes work while meeting multiple deadlines
• Works varied shifts as scheduled and/or needed

77211370 Patient Financial Services