GBMC HealthCare

Not-for-profit health system operating hospitals

Billing Specialist - Medicaid/Medicare

Accounts Payable/ReceivableConfirmed live in the last 24 hours

Full-timeHunt Valley, Cockeysville, MD, USA$19.92 - $29.87In-person

About the Job

Requirements

A high school diploma or equivalent is required.
Two years of medical billing experience and one year of electronic billing experience are required.
Thorough knowledge and understanding of medical billing, insurance, and private pay are required.
Knowledge of medical billing requirements for Medicare, Blue Cross, Medical Assistance, commercial insurance, and HMO carriers is required.
Strong collection skills, including claims follow-up and revenue cycle practices, are required.
Strong computer skills, including electronic medical record knowledge and Microsoft Office, are required.
Strong interpersonal skills are required.
Verbal and written communication skills for interacting with patients, families, insurance companies, and healthcare providers are required.
Ability to investigate issues, find solutions, and work under pressure to resolve billing issues is required.
Ability to manage multiple tasks, prioritize, and meet deadlines is required.
Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracy is required.
Ability to sit, concentrate, and pay close attention to detail is required.

Responsibilities

Perform billing and collection functions on account balances within assigned financial classes under direct supervision.
Ensure timely submission and follow-up of claims within assigned financial classes.
Post payments in Epic and perform eligibility, verification, and authorization requests as needed.
Manage assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.
Investigate claim denials or rejections and complete functions to resolve claims.
Use available tools, including online access, calls to insurance companies, and work with provider representatives, to resolve claims.
Identify appeals and prepare and submit appeals for denied claims, understanding the additional documentation necessary for an appeal.
Identify accounts with secondary liability, perform secondary billing, follow up on unpaid balances, and bring claims to resolution.
Identify patient self-pay balances, bill patients or families timely, and follow up as necessary, including by phone.
Process late-charge claims, claim resubmissions, and corrections to payors.
Enter and post payments to patient accounts based on remittance advice review.
Reconcile accounts and ensure underpayments or overpayments are corrected.
Respond to patient and third-party payor inquiries about patient accounts by email, telephone, mail, and in person.
Audit primary patient bills for submission to third-party payers through electronic billing or manual claim submission.
Maintain detailed and accurate billing records for auditing and regulatory compliance, and maintain thorough records of communications with insurance providers and patients regarding claims.
Participate in meetings with provider representatives to resolve denial discrepancies.
Develop an in-depth understanding of hospice billing regulations and ensure compliance with federal, state, and local billing laws, including HIPAA regulations.
Prepare reports to managers recommending accounts for bad-debt adjustments and maintain lost revenue below 1% of net healthcare revenue.
Recommend accounts for transfer to bad debt.

Desired Qualifications

An associate’s degree is preferred.
Epic experience is desired.
Excel is preferred.

Under direct supervision, performs all billing and collection functions on account balances within assigned financial classes. Ensures timely submission of all claims and timely follow up. Posts payments in EPIC. Perform eligibility, verification and authorization requests, as needed.

Education

High School diploma or equivalent required. Associate’s degree preferred.

Experience

Two years of medical billing experience and one year experience with electronic billing.

Epic experience desired.

Knowledge, Skills and Abilities

Thorough knowledge and understanding of medical billing, insurance and private pay.
Knowledge of all medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriers
Strong collection skills, including claims follow-up, revenue cycle practices
Strong computer skills, including EMR knowledge and Microsoft Office. Excel preferred.
Strong interpersonal skills
Excellent verbal and written communication skills for interacting with patients, families, insurance companies and healthcare providers.
Strong ability to investigate issues, find solutions, and work under pressure to resolve billing issues.
Efficient in managing multiple tasks, prioritizing, and ensuring deadlines are met.
Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracy

Licensures, Certifications

N/A

Principal Duties and Responsibilities

Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.

Claims Billing Processes

Ensures timely submission of all claims within assigned financial classes.
Ensures timely follow up of all claims within assigned financial classes

Claim Resolution Processes

Investigates claim denials or rejections
Completes functions in order to resolve claims

Uses all available tools such as but not limited to: Online access, calling the insurance companies; working with provider representatives.
Identifies appeals
Identifies secondary billing for accounts with secondary liability; follows-up on any unpaid balances. Brings these claims to resolution.
Identifies patient self-pay balances and bills timely to patient/family. Follow-ups as necessary including calling for follow up.
Process any late charge claims, claims resubmission and/or claims corrections to payors.
Enters and posts payment to patient accounts based on remittance advice review.
Reconcile accounts and ensure any underpayments or overpayments are corrected
Responds to patient and third-party payor inquiries regarding patient accounts via e-mail, telephone, mail, and in person.
Audits primary patient bills for submission to third party payers via electronic billing or manual claim submission.
Maintain detailed and accurate billing records for auditing purposes and compliance with industry regulations
Maintain thorough records of all communication with insurance providers and patients regarding claims.
Participate in meetings with Provider Reps to resolve denial discrepancies
Prepare and submit appeals for denied claims. Understanding of additional documentation necessary to submit an appeal
Obtain an in-depth understanding of hospice billing regulations. Ensure compliance with federal, state and local billing laws, including HIPAA regulations.
Prepare reports to managers recommending accounts for bad debt adjustments. Maintaining lost revenue at a level of less than 1% of net healthcare revenue
Recommends accounts for transfer to bad debt.

Physical Requirements

Ability to sit, concentrate and pay close attention to detail

Working Conditions

Normal office environment with little exposure to excessive noise, dust, temperatures and the like

Conditions of Employment

N/A

All roles must demonstrate GBMC Values

GBMC Values

Value Description

Respect

I will treat everyone with courtesy. I will foster a healing environment.

Treats others with fairness, kindness, and respect for personal dignity and privacy
Listens and responds appropriately to others’ needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

Meets and/or exceeds customer expectations
Actively pursues learning and self-development
Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

Sets a positive, professional example for others
Takes ownership of problems and does what is needed to solve them
Appropriately plans and utilizes required resources for various job duties
Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

Works cooperatively and collaboratively with others for the success of the team
Addresses and resolves conflict in a positive way
Seeks out the ideas of others to reach the best solutions
Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

Demonstrates honesty, integrity and good judgment
Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

Embraces change and improvement in the work environment
Continuously seeks to improve the quality of products/services
Displays flexibility in dealing with new situations or obstacles
Achieves results on time by focusing on priorities and manages time efficiently

Pay Range

$19.92 - $29.87

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

About the Company

GBMC HealthCare

Not-for-profit health system operating hospitals

GBMC HealthCare owns and operates Greater Baltimore Medical Center (GBMC), a regional community hospital in Towson, Maryland. It also includes GBMC Health Partners, a network of more than 300 primary care providers and specialists; Greater Baltimore Health Alliance; the GBMC Foundation; and Gilchrist, Maryland’s leading nonprofit provider of serious illness and end-of-life care. The organization coordinates hospital care, outpatient services, and support through its network to deliver medical services to the community. It aims to educate the next generation of clinicians while pursuing high-quality, patient-centered care for every patient and family, aligning care with what the patient would want for their loved ones. Its goal is to improve health outcomes for the community by providing comprehensive medical care, education, and support across its facilities and programs.

Company size: Not listed
Company stage: Not listed
Total funding: Not listed
Headquarters: Baltimore, MD
Founded: 1960

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