Billing Specialist II - Home Health Care/Hospice - Detroit, MI

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GENERAL SUMMARY
Under minimal supervision, is responsible for the Henry Ford Health System Insurance accounts receivable. Identifies and determines in accordance with established policies and procedures - the accuracy and completeness of patient financial, insurance and demographic patient information to ensure compliant claims to Third party payers. Resolves problem accounts from payer denials and follows up on any claims that require a payer response. Responsible for the billing and collection of payments for all Henry Ford Health System hospitals, outpatient clinics and employed physicians.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Submit third party claim forms (i.e. UB04 or 1500) through the claims editing software. Understands the claim editing process and resolving the edits based on appropriate department procedures regarding claim submission.
• Evaluate and investigate appropriate actions to be taken in order to resolve outstanding receivables, in accordance with department goals. Utilize various resources such as third-party publications, procedure manuals and participating contractual agreements, etc.
• Understand and resolves third party rejections using the payer and the billing systems
• Utilize various resources such as third-party publications, procedure manuals and participating contractual agreements, etc.
• Working knowledge of internal and external revenue cycle systems to manage receivables.
• Expert knowledge in all claims processing, including claims submissions, denials, and follow up procedures used to train other team members
• Independently interact with various levels of management, physicians, clinic personnel to identify process improvements to enhance billing processes
• Represent the CBO in all communications with external customers, including patients, third party insurance companies, auditors, lawyers, etc. May also attend external seminars, medications, and court sessions
• AND MORE...