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Job SummaryProvide an escalated level of claim processing to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines. Resolves more complex billing issues and provides training and mentoring to those in a Biller I role.
Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:
*Supportive work culture
*Medical, Vision and Dental Coverage
*Retirement Plans, Health Savings Account, and Flexible Spending Account
*Paid Time Off Accrual Bank
*Opportunities for growth and advancement
*Excellent pay differentials on qualifying positions (extra pay for working evening, nights or weekends)
- Demonstrates application of compliance standards and payer specific data to properly file claims and ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback.
- Proficient in third party payer procedures including, but not limited to: Blue Cross, Medicare, Medicaid, Indian Health Services, TriCare, and all other third party contractual agreements as required. May be asked to demonstrate specific knowledge for more complex billing models, such as, but not limited to: rural health and dialysis.
- Knowledgeable in split claim processes, specific to governmental payers.
- Demonstrated knowledge of 24/72 hour overlap rules in move charges and prevent denials.
- Thorough understanding of the Medicare portal in order to adjust and void claims and verify eligibility.
- Partner with internal caregivers to resolves complex billing issues for the self-pay and customer service teams.
- Monitor department metrics to draw conclusions regarding claims submission issues that might require Compliance and Charge Master staff to resolve, or HIPAA transaction code set review. Research payer requirements and offer suggestions to leadership for claims submission issues.
- Manages and reconciles daily claim runs between EPIC and clearinghouse as needed.
- Proficient in working denial follow up and first level appeals.
- Provide training and mentorship to other caregivers.
- All other duties as assigned.
Education - High School Diploma/GED Equivalent in General Studies
Certifications - Certified Revenue Cycle Specialist Professional (CRCSP) - American Association of Healthcare Administrative Management (AAHAM)
Experience - 1+ years of Clerical Experience; 1+ years of Medical Patient Accounts/Financial Services ExperienceSedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.
Job FamilyInsurance Services
DepartmentCS Provider Patient Financial Services
Scheduled Weekly Hours40
Employee TypeRegular 15 Corporate Services Division
Make a difference. Every day.
Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.
COVID Vaccination Statement
Ensuring the safety and well-being of our patients, visitors, staff, and communities is our deepest commitment at Monument Health. As a condition of employment, Monument Health requires all new hires to be fully vaccinated for COVID-19, unless there is an approved exemption. New hires will be required to have at least one dose of the vaccine prior to starting employment, with a second dose scheduled, or submit proof of previous vaccination.Apply