Medical Insurance Billing Specialist

We believe Pullman Regional Hospital is extraordinary.

We are a self-sustaining, patient and employee-focused, award-winning hospital with a unique, open, collaborative and inclusive culture.

On a daily basis, more than 500 employees serve patients and communities through Pullman Regional Hospital, the Foundation, and our network of clinics. We are one of the largest employers in Pullman, WA and a community leader in healthcare and philanthropic activities. Together, we continue to raise the bar of expectation for quality healthcare and the patient experience. In this way, the extraordinary for all others becomes the expected at Pullman Regional Hospital.

Our greatest asset is our people. This is our most worthy investment, and it's why we hire passionate people who are aligned in our mission to nurture and facilitate a healthier quality of life for our region.

Hours: M-F 8:00 am to 5:00 pm

QUALIFICATIONS:
Education/Training: High School Diploma or equivalent. Prefer an Associates Degree in Business or related field.

Experience: Medical billing experience helpful.

License/Registration: None required.

Population Served: N/A

ESSENTIAL FUNCTIONS:
Planning and Prioritizing

Processes daily explanation of benefits for insurance companies. Reviews and processes daily correspondence for insurance companies. Calls accounts on Aged Trial Balance; all accounts over 90 days are a priority. Calls accounts on Aged Trial Balance; all accounts over $1,000 are a priority. Posts payments for insurances for individual patient accounts. Prepares paper claims with supporting documentation and check for accuracy. Cleans all claim edits on electronic billing system checking for inconsistencies, missed charges or other billing errors. Makes any claim adjustments in the host system daily. Compiles batch information on reconciliation sheet and balances to bank deposits.

Information Gathering

Reviews credit balances and processes according to departmental policy. Obtains referral and authorization information from physician offices as necessary. Understands individual insurance company contracts and reviews reimbursements for accurateness, verifying all contractual allowances are correct. Gathers attorney billing information and works with HIM department for billing purposes.

Decision-Making

Exhausts all other resources to receive reimbursement on a claim prior to turning account balance over to the patient. This includes calling patient/guarantor to obtain necessary documentation and/or information, and calling physicians offices for any other pertinent information. Answers client inquiries regarding any billings.

Communication

Communicates appropriately with patients, coworkers, physician offices as well as members of ancillary departments throughout the hospital and any other individuals necessary to perform essential job functions. Answers patient inquiries regarding account information. Maintains records, documentation, and account follow-up status on mainframe computer system and in the client files. Communicates payment options to patients with copay or coinsurance balances in order to receive timely payments.

Technical Proficiency

Produces and verifies for accurateness all secondary and tertiary billings making any adjustments as necessary. Produces accurate adjustments as necessary on accounts. Adjusts any account information in order to print an accurate, clean statement for patient/guarantor. Utilizes the insurance website and/or One Health Port services to verify eligibility and check claim status on appropriate financial classes. Reports bad debt payments to agencies along with other pertinent information while making necessary adjustments on agency accounts. Processes and updates all claim check rejections daily.

Teamwork

Assists other patient account representatives with questions regarding cross over claims. Assists Patient Financial Services Director with special projects or assignments as requested. Participates in monthly staff meetings and quarterly joint staff meetings between billing and registration.

Quality

Researches denials, calls insurance companies, doctors’ offices, or patient to resolve denial issues in a timely manner. Balances cash reconciliation sheet with actual batches prior to deposit.

Outcomes

Participates in committees or task forces as requested or required.

Personal Education

Attends ongoing educational activities as necessary to acquire and maintain competency in medical billing compliance by attending conferences, seminars, and reading appropriate material.

Work Effectiveness

Utilizes the reminder systems for efficient follow-up on accounts. Uses the reminder system to inform other patient account representatives of account activity.

Reliability

Demonstrates promptness in reporting to work and compliance with meal and break schedules. Completes requested information in a timely fashion. Takes initiative to do other duties as needed.

Education of Others

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