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Job Information

Bozeman Health Remote Insurance Claims Billing Specialist in Bozeman, Montana

Position Summary:

The Government Claims Billing Specialist is responsible for reviewing claims as they go to Medicare/Medicaid to ensure compliance to Medicare/Medicaid billing regulations, especially meeting bundling requirements between Meditech and NextGen. Charged with the duty to follow up on all claims not paid timely, to appeal appropriate denials and refer them to the Appeals Coordinator, and to keep supervisors abreast on trends that need attention.

Minimum Qualifications:

  • High School Diploma or Equivalent

  • Two years of healthcare clinic/hospital billing experience

  • Preferred: Associate or Bachelor’s degree in Business Administration or Accounting

  • Preferred: Government billing experience

Essential Job Functions:

  • Reviews claims in the Medicare/Medicaid systems and with Medicare HMOs to ensure that claims are error free and will be paid within allotted time.

  • Generates telephone calls to insurance carriers to follow up on claims using electronic worklist and reports generated for this purpose. Follows up on all unpaid claims through phone contact or written correspondence to ensure that no account reaches 180 days old from discharge date and still due by insurance.

  • Reviews other claims for services done on the same calendar day on the same patient, or within 72 hours preceding an inpatient stay (Medicare only), and bundles charges according to Medicare/Medicaid guidelines.

  • Fixes claims that contain errors based upon why the claim is not paid.

  • Communicates with Billing Supervisor, Director, Appeals Coordinator, Coding Supervisor and Compliance Officer regarding claim errors to reduce problems in the future.

  • Helps Customer Service with patients billing questions regarding medical bills and help resolve in any way that is satisfactory to the patient.

Knowledge, Skills and Abilities

  • Demonstrates sound judgement, patience, and maintains a professional demeanor at all times

  • Ability to work in a busy and stressful environment

  • Creativity, problem analysis and decision making

  • Ability to work varied shifts

  • Exercises tact, discretion, sensitivity and maintains confidentiality

  • Computer applications, MS Office, EMR, internet applications and standard office equipment

  • Ability to analyze, organize and prioritize work while meeting multiple deadlines

  • Self-directed, completes assignments accurately, thoroughly and with minimal oversight

  • Detail oriented, organizational skills and the ability to prioritize

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified.

77211370 Patient Financial Services