Billing Specialist

Analyzes, investigates, and resolves claims and billing information errors associated with complex inpatient and outpatient medical insurance claims. Ensures compliance with managed care guidelines and organizational policies while supporting Memorial Health System performance standards of safety, courtesy, quality, and efficiency.

Responsibilities

• Review daily assigned billing claims and determine which require further analysis or action.
• Investigate incomplete or incorrect billing claims and resolve complex errors.
• Prioritize claims and file them electronically or via paper claim in accordance with insurance guidelines and processing procedures.
• Research and resolve complex patient insurance account issues and report trends to management when appropriate.
• Review rejected account information and resolve the reasons for rejection.
• Provide input on system edits to improve consistent and compliant claims processing.
• Respond to internal requests regarding coding, billing, and claims processing.
• Communicate with internal departments, patients, payors, agencies, insurance carriers, service providers, and collection agencies.
• Make corrections to charges and contractual allowances within scope of authority.
• Research late charges and adjust patient accounts when appropriate.
• Calculate write-off amounts and obtain required management approvals.
• Document claim and payment status in online systems and electronic files.
• Ensure compliance with managed care contract guidelines to support timely reimbursement.
• Assist with special projects, analyses, and audits as needed.
• Cross-train on other unit duties and serve as backup when necessary.