Responsible for working and editing daily downloads of assigned Managed Care/HMO claims to ensure timely transmission of accurate, clean claims.
This role identifies and obtains invalid or missing claim data by communicating with other departments to secure or correct information that prevents claim transmission. The position protects payer filing deadlines by using available resources to resolve held claims and ensures compliance with regulatory, contractual, and Baptist Health South Florida guidelines.
Additional responsibilities include supporting billing queues as needed, assisting with claim resolution, using system resources to address claim issues, reporting billing system problems to management, and helping other billing specialists with claims or assigned projects.
High school diploma, certificate, GED, training, or equivalent experience required.
- AA preferred or equivalent
- 3 to 5 years of prior billing experience required
- Managed Care/HMO contract billing experience required
- Knowledge of claims billing and required fields on 1500 and/or UB forms for hospitals and diagnostic facilities
- Coding background or coding certification such as CPC, CPC-H, CCS, or RMC is a plus
- Experience in business office functions such as collections, refunds, review, and adjudication of claims is a plus
- Knowledge of medical terminology, Correct Coding Initiative, revenue codes, DRG guidelines, ICD-9/10, CPT-4, modifiers, HCPCS codes, HIPAA regulations, and statutory regulations
- Experience with online verifications (DDE) and Microsoft Suite
- Strong analytical, critical thinking, problem-solving, mathematical, writing, and interpersonal skills
- Ability to communicate effectively with other departments
- Strong time-management skills and ability to multitask under pressure and meet deadlines
Career growth and development opportunities
- Comprehensive health and wellness resources
- Wellness program that may help employees eliminate their medical plan deductible
- Tuition reimbursement
- Supportive career development through a "grow our own" philosophy
- Opportunity to work for a large, mission-driven healthcare organization
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago