Advanced Billing Specialist

This role supports our customers with medical billing including collections and denial/appeal follow up.

You use your advanced skill set to establish new techniques and approaches, working with minimal supervision and considerable latitude for independent judgement. You complete difficult assignments without assistance, mentor less experienced team members, and may assist supervisors and managers.

The role you play

An effective Advanced Medical Billing Specialist will help the organization on a whole achieve success through:

• Living our Tegria values: Respect Every Person, Act with Integrity, Strive for Better, Embrace Change, Deliver as a Team
• Works accounts from assigned area(s) to maximize reimbursement
• Ability to resolve payer rejections and denials through the appeals process as required by each payers contracting agreements
• Performs systematic, consistent, and timely follow-up. Taking appropriate action to process accounts to resolution
• Responsible for working payer correspondence, edits, and aged accounts receivable, identifying, and correcting billing errors
• Resolves unpaid/under-paid claims and collections on behalf of clients
• Obtain claim status via various methods (telephone, internet, fax)
• Review and interpret contractual terms for managed care, commercial, Medicare, Medicaid and/or worker’s compensation
• Contacts various payers and patient to collect outstanding accounts. Tracks and enters all call for documentation, trending, and reporting.
• Identifies contractual and administrative adjustments
• May perform billing functions via electronic and hardcopy submission
• Ascertains account information and corrects charge and claim discrepancies. Makes necessary corrections regarding insurance data or patient’s registration
• Obtains supporting documentation regarding insurance follow-up efforts
• Corrects clearinghouse and payer rejections daily, notifying management of trends
• Uses third-party software applications such as payer websites, Medicare DDE/FISS, clearinghouses, and chargemaster tools
• Review and responds to insurance/patient correspondence timely
• Identifies billing issues and trends and report to management any concern or discrepancies in a timely manner
• May compose correspondence including claim forms, appeals, and notification to applicable parties
• Contact and educate patients and guarantors regarding necessary steps to resolve an outstanding insurance balance while providing exemplary customer service
• Maintains ongoing knowledge of third-party billing requirements. Understands billing timeliness and urgency in meeting all claim and filing deadlines.
• Keeps current with knowledge of professional payer contracting agreements
• Audits and reviews daily tasks to ensure accuracy and completeness prior to end of work shift. Balances and closes batches in a timely manner
• Takes patient phone calls to resolve questions, issues, and concerns
• Identifies MEDITECH system issues that impact the payment of a claim or the billing of an account and reports issues to the billing analyst for resolution
• Participates in internal team and external customer meetings
• Works directly with the coding staff on denials and claim rejections
• Attending department meetings
• Maintaining and increasing your skills, developing proficiency in the role
• Consulting with more senior team members on work approach and work product
• Performing other duties as assigned
• Working independently to complete assignments
• Establishing new techniques or approaches to increase efficiency and effectiveness
• Advising less experienced team members on work approach and work product
• Assisting supervisors and managers, as needed

What we’re looking for

We expect:

• High school diploma or GED
• 5+ more years related experience
• Able to work successfully with minimal supervision and with considerable latitude for independent judgement
• Demonstrated ability to assist and mentor less experienced team members
• Working knowledge of insurance; PPO, EPO, HMO, Medicare, Medicaid, Worker’s Compensation.
• Knowledge of computerized registration, billing, collection, and problem resolution procedures
• Electronic health record experience (Epic, Cerner, Meditech etc.)
• Ability to work independently and meet set production and quality goals
• Familiarity with medical terminology, coding (CPT/ICD-10/HCFA, UB04, HCPCS, DRG and authorizations/referrals
• Excellent customer service, communication (written and verbal), interpersonal and organizational skills
• Ability to navigate health plan websites to verify eligibility, benefits and claim status
• Must be able to work in a fast-paced department and handle multiple tasks, work with interruptions, and deal effectively with confidential information
• Able to work successfully with moderate supervision and follow instructions and procedures.
• Able to communicate tactfully and firmly with patients, providers, medical records staff and third-party insurers.
• Must have a private, secure workspace available at home and access to internet with speed sufficient to perform the job
• W2 project-based consultants will be expected to provide a computing device that adheres to industry standards and security best practices to use in satisfying the Project Services on behalf of Tegria.

We expect:

• Previous experience with numerous payer systems
• Previous experience in medical billing
• Previous experience with MEDITECH and Medicare DDE/FISS

Success Criteria

People who are successful in this role…

• Open to feedback and have a desire to grow their knowledge of revenue cycle claims and billing
• Comfortable and accountable working in a remote work environment – video conference calls, share virtual work tools/spaces, etc. are common
• Demonstrate “owning” their work and seeing it through to the finish
• Not afraid to ask questions or ask for help
• Clear and concise in their written and verbal communication
• Detail-oriented – able to catch the small stuff
• Thrive under the pressure of time constraints
• Customer service oriented

Need a few more details?

Compensation: $46,000-56,000/yr.

Status: Exempt | Full-time

Eligibility: Must be legally authorized to work in the United States without sponsorship

Work Location: This position is remote. Must work in a location within the United States.

Travel: 100% remote

Benefits Eligibility: Eligible

Now, a little about us ...

At Tegria, we tackle challenges both big and small to help move healthcare forward. We draw from our extensive experience and partnerships across healthcare and technology to help our clients enhance technology, financial performance, operations, and care delivery.

And at the very core of this vital work is our incredibly talented people.

People with different backgrounds who welcome challenge and change. People who listen first, ask hard questions, and make decisions to cultivate a culture of equity and inclusion. People who chase after goals, growth, and generosity.

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Perks and benefits

We’ve carefully designed our benefits package to meet you wherever you are in your life and career.

Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.

Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.

And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls thrown your way.

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Tegria is an equal employment opportunity employer and provides equal employment opportunities (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. All qualified candidates are encouraged to apply.