Billing Specialist I - FT - Days - MSS

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary:

The Billing Specialist is responsible for resolving claim edits for payors using the knowledge of the appropriate billing form and billing guidelines as well as various insurance contracts and payment methodologies to ensure a compliant claim. Reviews the claims to confirm the correct insurance filling order to ensure the correct payment at the time of initial submission. Ensures compliant billing based on the Office of Inspector General (OIG), CMS, HIPPA and any specific payor regulation. Proactively works accounts to maximize accurate and timely submission of claims utilizing knowledge of all billing guidelines.

Responsibilities:

Documents all billing activities in patient account record to accurately reflect what changes have been made to the claim/or insurance information. Identifies billing errors trends and directs these trends to management for review and/or resolution.Enters all Recovery Audit Contractor (RAC) reviews into the third-party software. Requests medical records and coordinates the response to the RAC request.- for Hospital billingRequests and submits appropriate medical records to selected insurance companies or Medicare either for initial billing requirements or to respond to Additional Documentation. Requests (ADR) for oncology services. Works with audit nurses on coordination of medical records and letter of medical necessity for a formal appeal.- for Hospital billing.Resolves edits in charge review/charge router work queues to ensure complaint billing based on medical documentation - for Physician Billing.Resolves error in claim edit work queues for accurate and timely submission of paper and/or electronic claims. Uses OIG, CMS and HIPPA guidelines to refer a claim to the appropriate department for review and resolution of the errors, as needed.Resolves payor gateway rejections using payor systems (EDI) information and analysis of the claim issue - for Hospital billing.Reviews coding to ensure that the procedures coded are billable according to the regulations set by the different payors. Adds applicable billing modifiers, when needed. Resolves clearinghouse errors and resubmits the claim for processing. Bills secondary or tertiary insurance by interpreting the explanation of benefits (EOB) from the payor. Adjusts or bills late charge/credit replacement claims using insurance payment methodologies.Works in appropriate claim system for Medicare and Medicaid to resolve overpayments by the payor by updating claim information in their system. - for Hospital billing.Resolves claims edits monthly for skilled nursing/long term care for accurate and timely submission of paper and/or electronic claims.- for Hospital billing.Confirms and corrects patient insurance information by calling the guarantor and/or mail inquires for accident insurance, workman's comp, or other needed insurance information. Updates account with any discovered insurance and notates the account with the new insurance information. Applies the unsolicited 271 transaction to add the insurance to the account, when applicable. Applies the unsolicited 271 transaction to add the insurance, when applicable - for Hospital billing.Creates and submits Part B only claim to Medicare for inpatient services when Medicare Part A benefits are exhausted. If another insurance is also available for billing, reviews and submits a claim for the non-covered Part A services to that payor for payment.- for Hospital billing.

Competencies:

ACCOUNTABILITY, ACCURACY, ANALYSIS AND DECISION MAKING, BILLING, CUSTOMER SERVICE, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

High School Diploma or Equivalent (Required)

Additional Job Information:

Complexity of Work: Requires excellent communication skills, critical thinking skills, decisive judgment and the ability to work with minimal supervision. Knowledge of UB–04 and/or CMS 1500 form, billing guidelines, insurance contract and payment methodologies. Must be able to work in a stressful environment and take appropriate action.

Required Work Experience: No prior experience required. For Hospital Billing, the knowledge of UB-04 and EPIC hospital billing experience preferred. For Physician Billing, the knowledge of CMS 1500 and EPIC professional billing experience preferred.

Working Conditions and Physical Requirements:

• Bending and Stooping = 0%
• Climbing = 0%
• Keyboard Entry = 80%
• Kneeling = 0%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 0%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 80%
• Running = 0%
• Sitting = 80%
• Squatting = 0%
• Standing = 80%
• Walking = 80%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 80%
• Distinguish Color = 0%
• Seeing - Far = 80%
• Seeing - Near = 80%
• Bio hazardous Waste = 0%
• Biological Hazards - Respiratory = 0%
• Biological Hazards - Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 0%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 80%
• Domestic Animals = 0%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 0%
• Potential for Physical Assault = 0%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift:

Primarily for office workers - not eligible for shift differential

Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net

Memorial Experience - Our Values

Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well-being, and quality of life of the people entrusted to our care. This unwavering commitment to our service vision makes the difference and is the foundation of The Memorial Experience.

Deeper Caring. Smarter Healthcare.
Talk to our patients and their families about “Deeper Caring,” and they'll tell you stories about miracle babies, lives saved through sheer determination, and the comforting kindness of others. About people who advocated for the family’s best interests and cared for them in body, mind, and spirit.

For our employees, “Smarter Healthcare” means constantly improving how we deliver care. It could be a new technology, a streamlined process, or a cutting-edge program leveraging our system strengths. But, no matter how you look at it, our service vision is integral to our culture today and what we strive to be tomorrow.

We invite you to share in the Memorial Experience – where touching lives, lifting spirits, and healing the human body is our profession’s greatest privilege and reward.

Veteran's Preference

Be where you are valued. Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job.

Who is eligible for Veteran’s Preference?
We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard.

What should I do if I am eligible for Veteran’s Preference?
You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status.

How does Memorial verify that someone is eligible for Veteran’s Preference?
We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty.

How often can an eligible person claim Veteran's Preference at Memorial?
There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere.

What if there are two equally qualified, preference-eligible job applicants?
In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to:
An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability.
A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment.
A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power.

What do I do if I am denied Veteran's Preference?
If you feel you have been unfairly denied Veteran’s Preference by Memorial Healthcare System, please contact EmployeeRelations@mhs.net. You may also file a complaint with the Florida Department of Veterans’ Affairs (FDVA).

Important Legal Notices

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• Florida Civil Rights Act
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• Family and Medical Leave Act (FMLA)
• Employee Polygraph Protection Act (EPPA)
• E-Verify™ Participation Notice – English
• Right To Work Notice – English
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• Right To Work Notice – Spanish

Florida Public Records Law

Memorial Healthcare System is subject to the Florida Public Records Law. All information provided in connection with your application for employment will be a public record and subject to release upon request, unless considered exempt or confidential.