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BUSINESS OFFICE- INSURANCE BILLING SPECIALIST - BUSINESS OFFICE
Reports To: Business Office Lead

Employee Type: EXEMPT X NON-EXEMPT

POSITION SUMMARY:

Insurance Billing Specialist is accountable for processing insurance claims for Mayers Memorial Hospital District. Including but not limited to submitting claims, processing refunds, and claims follow-up.

This job description is intended to identify some of the primary duties and responsibilities. MAYERS MEMORIAL HOSPITAL DISTRICT reserves the right to modify, supplement, delete or augment the duties and responsibilities specified in this position description, at MAYERS MEMORIAL HOSPITAL DISTRICT’S sole and absolute discretion.

POSITION QUALIFICATIONS:

1. Minimum of two years medical billing experience preferred
2. Minimum of one year of office or hospital clerical experience preferred
3. Knowledge of medical terminology preferred

POSITION RESPONSIBILITIES:

General Competencies:

1. Knowledgeable on insurance and reimbursement process.
2. Good math and data entry skills.
3. Exercise good judgement and discretion.
4. Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information.
5. Proficient in use of computers and common office equipment.
6. Good written and verbal communication skills.
7. Good telephone and patient relation skills.I
8. Detail oriented and ability to prioritize work.

Specific Competencies:

1. Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
2. Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper claim forms.
3. Answers patient questions on patient responsible portions, copays, deductibles, write-off’s etc. Resolves patient complaints or explains why certain services are not covered.
4. Follows up with insurance company on unpaid or rejected claims, Resolves issue and re-submits claims.
5. For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer.
6. Follows HIPAA guidelines in handling patient information.
7. Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered when billing for specialties.
8. May have to verify patient benefits, eligibility, and coverage.
9. Ability to look up ICD-10 diagnosis and CPT treatment codes from online service or using traditional coding references.
10. Submit requests for patient accounts to be adjusted to correctly reflect patient EOB from insurance company.

Professional Requirements:

1. Adheres to dress code; appearance is neat and professional.
2. Completes annual education requirements if applicable.
3. Maintains regulatory requirements.
4. Wears identification while on duty.
5. Attends annual evaluation and participates actively in this process.
6. Reports to work on time and as scheduled; completes work in designated time.
7. Attends all meetings as appropriate.
8. Exhibits the mission, ethics and goals of Mayers Memorial Hospital District in the performance of job duties.

WORKING CONDITIONS:

1. Willingness to work beyond normal working hours and in other positions temporarily when necessary.
2. Is involved with personnel, visitors and government agencies, etc., when necessary.
3. Must function independently, have personal integrity, have flexibility and the ability to work effectively with other personnel, clients and support agencies.

PHYSICAL REQUIREMENTS:

1. Sits, stands, bends, lifts, walks and moves intermittently during working hours.
2. Able to lift 20 lbs.

Additional Information
Position Type : Full Time
Shift : Day

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In 1949 a Chamber of Commerce hospital committee was formed and began taking the first steps toward a visionary project -Ward Memorial Hospital. The Chamber's "Hospital Committee" compiled the costs of building a new hospital to present to taxpayers -the first hospital bond issue was defeated in 1950. If at first you don't succeed, try, try again. After one private hospital discontinued practice due to inadequate facilities, leaving only one that could handle just 23 patients, the need for a county hospital was again fronted to the citizens in 1953. With the support of local doctors, civic groups and women's clubs, a bond election was called in March of 1954. In June of 1954 the voters voted six-to-one in favor of a county hospital.