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Develop strategic internal content and campaigns for Absa Group, a leading African banking group. Strengthen colleague engagement across digital communication channels.
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Wellstar Health System — Джорджия мен Оңтүстік Каролинадағы пациенттер мен қауымдастықтарға қызмет көрсететін ірі денсаулық сақтау ұйымы. 1992 жылы құрылған ұйым денсаулық сақтау қызметтерін ұсына отырып, клиникалық, әкімшілік және операциялық бағыттарда жұмыс істейтін кең ауқымды мамандарды біріктіреді. Ұйымның мансаптық бағыттарына денсаулық сақтау және медициналық сақтандыру салаларындағы мүмкіндіктер кіреді, сонымен қатар пациенттерге жанашырлықпен қарауға, құрметке, инклюзияға және қауымдастықпен байланысқа басымдық беріледі.
Remote Billing and Claims Specialist
Process electronic and paper healthcare claims for Wellstar Health System in a remote role serving payers and patients. Investigate edits, denials, eligibility issues, coding requirements, and billing discrepancies.
Сипаттама
- Prepare and submit accurate electronic and paper claims to third-party payers
- Investigate claim edits and payer rejections, researching issues and resolving them independently
- Review medical records and apply CMS requirements, CPT coding guidance, and departmental procedures
- Monitor clearinghouse activity through Change Healthcare and resolve related support issues
- Coordinate patient eligibility verification through external sources
- Record and clarify billing activity in the patient accounting system
- Resolve patient billing concerns while managing denial and insurance follow-up
- Include required payer documentation and send paper claims by mail
- Process adjusted, corrected, and rebilled claims
- Correct payer rejections, ICN errors, Master File issues, retro-review matters, transfer queues, and other work queue errors
- Review and override edits generated by external clearinghouse systems
- Submit claims for Railroad Medicare
- Recommend improvements to billing systems and processes
- Protect patient confidentiality and privacy under HIPAA requirements
- Communicate professionally with patients, families, colleagues, healthcare teams, HIM, Revenue Integrity, Patient Access, Patient Financial Services, and referral agencies
- Participate in staff meetings, in-service training, and continuing education
- Support special projects and performance improvement work
- Keep required competencies current and follow Wellstar policies, work standards, and code of conduct
Талаптар
- High school diploma or GED
- At least one year of medical billing experience, including familiarity with billing-related reporting
- Experience working with Medicare, Medicaid, and commercial medical payers
- Working knowledge of CPT and ICD-10 coding systems
- Understanding of medical billing and collection practices
- Consistent ability to meet deadlines and deliver results
- Effective communication and customer service skills
- Strong analytical ability and problem-solving skills
- Excellent time management and ability to work independently
- Knowledge of HIPAA guidelines and regulations
- Ability to follow CMS requirements, CPT coding guidelines, departmental procedures, policies, and other regulatory standards
- Ability to protect confidential information and patient privacy
- Ability to work with patients and families from varied developmental and sociocultural backgrounds
- Ability to use telephones, email, and other communication devices
- Ability to work with Epic EMR, external claim-scrubbing edits, clearinghouse platforms, and patient accounting systems
- Ability to process Medicare, Medicaid, commercial insurance, and Railroad Medicare claims
Артықшылықтар
- Opportunity to contribute to meaningful work
- Support for a more rewarding life
- Staff meetings, in-service training, and continuing education
- Participation in system-wide performance improvement initiatives
- Supportive work environment
- Full-time employment
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