Emerus

Senior Medical Billing Specialist

US-TX-The Woodlands
2 weeks ago
ID
2017-6018
Emerus Holdings Inc
Type
Full-Time
Shift Type
Days

About Us

Emerus is a nationally recognized, innovative leader in the delivery of inpatient, surgical, and diagnostic medical health care. Specializing in the identification, development and management of improved-access community medical facilities, Emerus provides cost effective, scalable growth opportunities to large-scale, national health care systems throughout the United States. 

 

By providing operationally efficient facilities and focused alignment with current health care trends, Emerus’ community-based hospitals prioritize limited inpatient stays, efficient emergency rooms and cost effective pricing in a smaller campus setting. Based in The Woodlands, Texas, Emerus has more than 1,400 employees, with expert concentrations in over 20 different fields throughout the medical industry.

Position Overview

The purpose of this position is to complete the timely and accurate submission of claims (i.e. insurance companies, Medicare and Medicaid, employers, individuals, etc.) for health services provided by the company to ensure prompt payment. This position is a “working” Lead position and is expected to work alongside staff as well as provide direction.

Essential Job Functions

  • Responsible for oversight of daily activities as they relate to the Medical Billing Team
  • Train and evaluate billing department staff- Develop and maintain procedures for efficient and accurate processing of claims
  • Perform Monthly Quality review for the staff based on established Metrics.
  • Complete daily billing process and ensure successful completion
  • Review and correct all claims returned by the clearinghouse, payer, or from internal edits
  • Follow-up and investigate any billing errors returned from payers. Work with respective team members/supervisors for resolution
  • Suggest billing component changes as necessary for payers
  • Work various reports (discharge not final billed, billing exceptions, etc) to ensure accurate classification of accounts and to ensure that all accounts have been final billed
  • Complete billing requests from team members for submission of claims not received by the payer and corrected claims as identified
  • Review and update demographic/guarantor/insurance data obtained in the registration process as necessary
  • Track claims made by the company to ensure successful transmission and receipt
  • Understands external rules and regulations as they relate to healthcare billing and collections e.g. Medicare, Medicaid, state laws, Health Insurance Portability and Accountability Act (HIPAA), etc.
  • Review, understand and correct Medicare claims in Medicare Claims Management system (DDE, Ability Ease) in accordance with Medicare guidelines.

Other Job Functions

  • Attend staff meetings or other company sponsored or mandated meetings as required
  • Perform additional duties as assigned
  • Willingness and ability to work overtime

Basic Qualifications

  • High School Diploma or GED, required
  • Previous Lead/Supervisor experience, required
  • 3+ years medical billing experience, required
  • Expert knowledge of the UB-04/CMS-1450 claim form, required
  • Expert knowledge of the HCFA-1500 claim form, preferred
  • Knowledge of state and Federal payment laws, required
  • Experience using a 10-key adding machine, required
  • Experience with spreadsheets (Excel) with moderate to advanced data manipulation, required
  • Experience using EPIC patient accounting system, preferred
  • Knowledge Medicare Billing Systems (DDE, Ability Ease) preferred
  • Position requires fluency in English; written and oral communication
  • Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic
  • Position requires fluency in English; written and oral communication

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