Description
PATIENT FINANCIAL SERVICES (PFS) ITEMIZED BILLING SPECIALIST
Contract: 12 months (W2)
Location: Rockville, MD 20852
Job Number: 62906
Client: One of the country's largest health care and health plan providers
Pay: $16/hr
Standard Work Hours: Flexible - normally M-F 8:30 AM-5:00 PM. Some adjustment may be needed as scheduling conflicts arise. There is also a possibility of adjusting the start and end times to accommodate the contractors schedule (within reason).
Essential Functions:
- Generates and analyzes applicable departmental itemized billing reports requested by members, attorneys and third party insurance adjusters according to departmental policy.
- Investigates and resolves situations which require research or adaptation of responses
and document action taken to resolve billing discrepancies and unusual charges and credits. - Process incoming correspondence and makes the determination of related billable and non-billable third party encounters for subrogation cases.
- Acts as a liaison to the Billing, Coding and Collection Units; provides assistance to other units with regard to itemized billing requests.
- Responds to the billing inquiries from members, attorney's, carriers, other units within PFS, as well as Membership Services and Patient Accounting, when applicable.
- Resolves account issues including resubmitting claim if not on file, verify/confirm patient information for reprocessing, identify information needed to correctly process encounter and generally work through issues in order to process requests quickly.
- Escalate problematic accounts to the attention of the Billing Coordinator in order to resolve issues quickly and efficiently.
- Provides feedback to Financial Coders regarding coding and billing edits.
- Receives and responds to incoming customer calls pertaining to the itemized statements.
- Interprets federal and state laws and regulations in all operating jurisdictions for TPL, WC CMS, NAIC.
- Communicates changes in regulations appropriately to all interested parties. Advise management of pending changes.
- Performs other duties as directed.
Required Education, Experience, and Skills:
- High School diploma or equivalent
- Minimum 4 years' relevant experience - billing/coding experience to include knowledge of CPT, ICD-9, HCPCS
- Experience with/knowledge of Worker's Compensation and Third-Party Liability
- Experience with/knowledge of commercial and Medicare billing procedures and regulations
- Knowledge of compliance medical and insurance terminology
- Familiarity with CMS 1500 and UB 92
- Knowledge of Microsoft Word, Excel, and Access
Preferred Education, Experience, and Skills:
- Bachelor's degree
- Billing and/or Coding certification
- Experience with/knowledge of HealthConnect, Lotus Notes, and Diamond
Interview:
- Face-to-face only - with manager and 1-2 team members
- Will cover candidate's background, experience in health care industry as relates to their daily tasks