Billing Specialist\Insurance Verification Clerk

Westwood Lodge Hospital is seeking a Full Time Billing Specialist/Insurance Verification Clerk for our Business Office

The Insurance Verification Clerk/Billing Specialist supports the delivery services and the financial goals and objectives of the organization through effective admission procedures and the effective day-to-day management of financial data.

Insurance Verification Resposbilities (Including but not limited too):

Verifies patient insurance benefits, sending written documentation to Hospital. Interacting regularly with insurers including communication of per diem rates. Obtaining pre-authorization when needed, ensuring the correct insurance agency, and the information is timely and noted in the patients financial chart. Assigns patient identification numbers and collates with admission documents, forwarding to the business office as required.

Receives and processes physician's orders for patient admissions and completes related admission procedures obtaining patient and other required signatures on voluntary admission or commitment papers obtaining various releases including patient activity participations, school records and immunization records (if child or adolescent), information to referral sources physician billing, and insurance companies. Completes necessary admission packet documentation in a timely manner, including: medical record number, patient I.D. number, insurance verification form, information regarding physicians orders, etc. Reviewing patient census for accuracy.

Verifies documentation on after hours admissions and follows up on day admissions. Verifies that appropriate documentation was obtained for all after-hour admissions performed by clinical unit. Completes patient's financial folder. Acquires any missing documentation. Follows up on any documentation left uncompleted form patient's initial time of admission.

Maintains necessary financial information, inputs appropriate information into the system. Maintains contract book. Enters critical patient insurer information daily, including company names, addresses, inpatient and outpatient coverage, per diem rates, and special information. Input patients' discharge diagnoses from medical records daily. Forwarding necessary documentation to other hospital departments and the Central Business Office.

RESPONSIBILITIES: (include, not limited to)

Billing:

Accurately prepares bills daily and submits them timely via paper or Electronically. Verifies receipt of bill to avoid timely filing denials. Reviews patient folders for completeness of patient insurance information and proper signatures. Verifies that computerized insurance documentation is up to date and accurate continuously throughout the accounts receivable process. Consistently completes edits on a daily basis. Performs end of day report functions, and performs purges every 90 days.

Collection:

Prioritizes follow-up on accounts as appropriate, but no less than every 30 days. Reviews EOBs for proper payment, documents any denials and resolves denied amounts on a timely basis. Ensures bad debts and denials are presented for write-off timely, with all completed supporting documentation.

Documentation Accuracy:

Maintains documentation on all third party billing contract rates and procedures. Ensures proper contractual discounts and codes are used to net accounts receivable. Documents notes completely and concisely regarding follow up activity, while keeping organized paper documentation. Performs other duties or tasks as assigned.

MINIMUM QUALIFICATIONS:

Education: High school diploma or equivalent required. Associates or Bachelors Degree preferred.

Experience: Familiarity with health care service delivery systems basic data entry skills with some computer experience strong customer service skills empathy attention to detail legible handwriting understanding of basic insurance procedures and of various levels and aspects of managed care.

Technical Skills: Proficiency in Microsoft Office programs and other office equipment. Familiarity with Med Series 4, EMDEON, and/or past Electronic Medical Billing desirable.

Age and Disability: Must possess knowledge and skills necessary to interact compassionately and appropriately with patients and families.

Other: Possess excellent verbal and written communication skills. Diplomacy and discretion are essential, as well as excellent organizational skills and the ability to prioritize multiple projects. Professional demeanor and appearance.

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