Billing Specialist - Home Health

The Home Health Billing Specialist is responsible for completing assigned tasks involved in claims submission to ensure payment from payors and reporting to management on observed trends and issues.

Job Relationships

Reports to the Insurance Review Manager

Principal Responsibilities

• Conducts medical insurance verification for patients to ensure the appropriate insurance is billed for services rendered.
• Analyzes and reviews claims to ensure that payer-specific billing requirements are met and are submitted timely.
• Collaborates with the appropriate management team members regarding late or missing documents required for billing.
• Monitors claims that meet billing requirements to be submitted on a daily basis.
• Manages the assigned portion of the AR, including appropriate and timely follow-up on all insurances, identifying issues and reporting trends.
• Determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
• Researches and writes appeals to insurance companies on denied accounts.
• Resolves outstanding account balances.
• Works with aging reports and follows up appropriately.
• Manages ADR or medical record requests and responds timely.
• Responds to insurance company requests for information.
• Must report all incidents to immediate Supervisor or Manager.
• Assist with special projects and assignments as directed.
• Must attend in-services and training relevant to position.
• Perform other job duties as assigned.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• High School graduate or GED required.
• Previous experience in a medical billing office required.
• Previous experience in Home Health billing and accounts receivable preferred.

Knowledge, Skills and Abilities

• Working knowledge of medical terminology preferred.
• Working knowledge of CPT and ICD-10 coding preferred.
• Computer, typing and calculator skills required.
• Must be able to work individually or on a team.

Working Environment

• Office environment, sitting for long periods

PHI/Privacy Level

HIPAA1

This position is employed to provide services for White Star, a not-for-profit affiliate of Springfield Clinic,