[Hiring] Billing and Claims Specialist II @Wellstar Health System

Role Description

The Billing and Claims Specialist II manages claim processes, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. Responsible for working claim edits within Epic EMR and external claim scrubber edits prior to final submission.

• Prepares and submits clean claims to third party payers either electronically or by paper.
• Analyzes, researches, and independently resolves claim submission edits and payor rejections.
• Assists with training of new Billing and Claims Specialist I team members.
• Works with clearinghouse, Change Healthcare, including appropriate follow-up and support issues.
• Focuses attention on payers with complex billing requirements and high dollar balances.
• Coordinates process of patient eligibility through various third-party sources.
• Provides support to provider sites for resolving Claim Edit issues.
• Ensures all billing activity on accounts is documented and explained in the appropriate fields.
• Identifies and resolves patient billing issues.
• Manages denial and insurance follow-up.
• Attaches documentation when required by payor for claim processing.
• Consistently meets productivity and quality standards in processing claims.
• Issues adjusted, corrected and/or rebilled claims to third party payers.
• Identifies opportunities for system and process improvement.
• Participates in testing for assigned software applications.
• Maintains strictest confidentiality, adheres to all HIPAA guidelines/regulations.
• Participates in daily claims credentialing related activities.
• Resolves and reviews daily credentialing denials and NPI related rejections.
• Performs other duties and responsibilities as assigned.

Qualifications

• High School Diploma / GED General or Bachelor's in a related field (preferred).
• CRCR - Certified Revenue Cycle Rep or CRCR-P - Certified Revenue Cycle Rep - Provisional (90 Days) within 90 Days.

Requirements

• Minimum 3 years medical billing experience, including knowledge of billing related reporting.
• Working knowledge of CPT and ICD-10 coding systems.
• Knowledge of medical billing and collection practices required.
• Good communication skills and customer service skills.
• Strong problem solving and analytical aptitude.
• Excellent time management skills and capacity to work independently.

Benefits

• Support to do more meaningful work.
• Enjoy a more rewarding life.
• Connect with the most integrated health system in Georgia.