Billing Executive

Responsibilities may include the following and other duties may be assigned:

As a Billing Executive for Patient Financial Services, the role involves the specialist to work closely with various departments to ensure accurate coding, compliance with payer requirements, and maximization of reimbursement on Patient Financial Service accounts receivable metrics.

• Review and analyze charge capture data for accuracy and completeness.
• Identify and correct charge errors and discrepancies.
• Collaborate with clinical and coding staff to resolve charge-related issues.
• Monitor and review billing processes to ensure compliance with payer guidelines.
• Identify billing errors and make necessary corrections to avoid claim denials.
• Ensure timely and accurate submission of claims to payers.
• Manage the resolution of denied claims by identifying root causes and correcting errors.
• Resubmit corrected claims to payers for reimbursement.
• Track and report on claim correction activities and outcomes.
• Ensure all billing and charge correction activities comply with relevant laws, regulations, and internal policies.
• Stay updated on changes in billing regulations and payer requirements.
• Experience with various insurance plans offered by both government and commercial insurances (i.e., PPO, HMO, EPO, POS, Medicare, Medicaid, HRA s) and coordination of healthcare benefits, including requirements for referral, authorization, and pre-determination.

Required Knowledge and Experience:

• Bachelor s degree in business or accounting major is preferred.
• 1-2 years experience in U.S Healthcare insurance collections, accounts receivable management, billing and claims processing, and insurance payor contracts.
• Advanced knowledge of insurance contracting, payor regulations, insurance benefits, coordination of benefits, managed care, and healthcare compliance, rules, and regulations.
• Advanced experience with reading, and understanding medical policy information, and utilizing insurance benefit and coverage information to recovery denied claims.
• Advanced experience with various insurance plans offered by both government and commercial insurances.
• Experience with medical billing and collections terminology - CPT, HCPCS, ICD-10 and NDC coding, HIPAA guidelines and healthcare compliance.
• U.S Healthcare Experience is must.