Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurance
follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge
of UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle
denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business
office responsibilities related to patient accounts, including charge import, diagnostics and procedural coding,
and claim follow-up with third-party payers to achieve a zero-balance resolution.
Special Instructions possibility of being remote and/or hybrid position after timeframe and all criteria are met ResponsibilitiesPromote the mission, vision, and values of the organization
· Import charges from queues in a timely manner and append modifiers or any required
information for claim transmission
· Review daily accounts that are ready to be billed in Waystar from Meditech
· Initiate correction on all claims with errors by the designated time
· Follow up on any correspondence that may have been received on that day or the
previous day
· Cross train on billing all lines of business to the different payers
· Pull listing of all accounts assigned to be follow up by specific payer
· Diagnostic and procedural coding
Follow-Up Responsibilities
· Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and
policies.
· Communicate with third-party representatives as necessary to complete claims processing and /or resolve
problem claims.
· Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and
rebilling, and denied claims for accounts.
· Maintain accounts receivable detail of their accounts through tasking.
· Maintains standards per payer for percentage accounts >90 days.
· Works minimum standard number of accounts per payer per day.
· Meets or exceeds collection goals by payer each month.
· Works all assigned accounts as assigned, depending on balance.
· Participates in educational activities and attends monthly department staff meetings.
· Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
· Other duties as assigned from time to time.
· Attend educational activities and monthly department staff meetings
· Perform other duties as assigned
Qualifications
Education
· High School Diploma or GED
Minimum Work Experience
· Six months previous experience in hospital registration, billing and collections, financial counseling, or customer service preferred
Required Skills, Knowledge, and Abilities
· Knowledge of medical terminology preferred · Basic computer proficiency · Typing speed: minimum 40 WPM · Familiarity with CPT and ICD-9 coding is helpful · Good written and verbal communication skills are essential for account follow-up