Billing Specialist

Previous Billing Experience is Required.

PRIMARY FUNCTION:
Under the direction of the Manager – Revenue Cycle in the Abington – Jefferson Health Physician Billing Office, the Physician Billing Rep – Accounts Receivable is responsible for receivables management of one or more insurance which may include any portions of the billing cycle: the daily batching and electronic submission of all claims, retrieving transmission reports, reviewing all edits, correction of denied claims, reconciling the process, processing payer rejections and doing reconsiderations/appeals while meeting the departments establishe benchmarking standards..

ESSENTIAL FUNCTIONS:
¿ Transmits claims on a daily basis. Monitors transmission reports to assure all claims are received and processed accordingly. Completes all payer rejections in a timely manner in accordance with Department Standards.
¿ Runs multiple scanned reports, and reviews claims for accuracy. Contact practice staff if necessary for clarification, and make corrections when need to ensure the claims will transmit electronically.
¿ Performs daily system update function timely. Batches claims according to specific EDI regulation/credentialing status for submission to the clearinghouse. Performs the 72 hour review and moves claims on a weekly basis.
¿ Identifies, separates and mails claims that require paper submissions for timely submission.
¿ Monitors payer edits and keeps the supervisor informed of any changes in regulations. Monitors provider enrollments to assure that claims process correctly to ensure timely reimbursements.
¿ Discerns discrepancies in either Explanations of Benefits or claim submissions through maintaining understanding of insurance companies’ rules and regulations.
¿ Reviews, researches and amends correspondence/Explanations of Benefits and makes appropriate adjustments to accounts as per third party regulations.
¿ Identifies and communicates possible system and reimbursement problems to facilitate an efficient and accurate review of the payers.

EDUCATIONAL/TRAINING REQUIREMENTS: Minimum high school graduate or graduate; some college or equivalent work preferred.
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CERTIFICATES, LICENSES, AND REGISTRATION:
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EXPERIENCE REQUIREMENTS:
Minimum of 2 years’ experience in a large physician network environment. Must be proficient in reading and understand third party remittance advice.
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ADDITIONAL INFORMATION:
Proficient in the use of Microsoft Office-Word, Excel, and knowledge of various PM systems. Must have a good understanding of CPT and ICD-10 codes. Proficient in Physician Billing systems, as well as proficiency using external computer-generated media to monitor and promote prompt and accurate patient account reimbursement.
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Conditions of Employment

Covid Vaccination is a requirement for employment at Jefferson for employees working at Jefferson’s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.

Jefferson Health delivers state of the art healthcare services to patients throughout the Delaware Valley and southern New Jersey. Jefferson (Philadelphia University + Thomas Jefferson University) provides more than 8,400 students from nearly 40 states and 40 countries with 21st century professional education. Combined, we have over 30,000 employees.

Jefferson Health, with 14 hospitals (seven are Magnet designated by the ANCC for nursing excellence) and 40+ outpatient and urgent care locations, offers a broad range of primary and complex, highly specialized care that touches the lives of more than four million patients annually. U.S. News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in eight specialties. Jefferson Health also includes the NCI designated Sidney Kimmel Cancer Center; it is one of only 70 such centers in the nation.

Thomas Jefferson University has ten colleges and three schools that offer more than 160 undergraduate and graduate programs. Our University is dedicated to inter-professional and transdisciplinary approaches to learning that offer a vibrant and expandable platform for professional education. Through this unique model, we are preparing our students for current and yet to be imagined careers.

As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.