At Wentworth-Douglass, we value people who contribute to patient-centered care that enhances community health; we recognize and reward those who share our values and transform our patients' lives. We invite you to explore opportunities, cultivate community wellness and professional growth.
Provides quality customer service though out all functions of the job. Demonstrates competence in the performance of duties and responsibilities related to organizational performance and billing requirements. Ability to perform as a Resource for the department
1. To be goal oriented, revenue driven, highly accurate, and motivated. Must be aware of all aspects of the Revenue Cycle. Primary duties include, but are not limited to, consistent follow up on unpaid claims utilizing aging reports, filing appeals, posting cash, and submitting clean claims via a clearing house. Job duties include both facility and professional billing.
a. Maintains workflow in an organized manner so as to facilitate the timely completion of work.
b. Team player with superb interpersonal skills and successful interaction with a wide range of individuals/groups.
c. Creative thinker who will establish and focus on priorities while identifying value added solutions.
d. Utilize account receivable aging reports to follow up on unpaid claims aged over 30 days.
e. Timely follow up on all insurance claim denials, exceptions, exclusions, or rejections.
f. Prepare in advance for payer team meetings including agenda and action items.
g. Respond to inquiries from insurance companies, patients, and providers in a timely manner.
h. Respond to emails from teammates within 48 business hours of receipt.
i. Meet deadlines.
j. Proactive self starter who is patient centered, quality driven and service oriented.
k. Positive, visible and confident biller with the ability to inspire, challenge and motivate self to achieve common goals.
l. Timely review of insurance distributed material and payer newsletters.
m. Ability to listen and assimilate input from colleagues, internal customers and peers.
n. Perform additional duties as requested.
o. Ability to perform as a resource to staff relating to billing and reimbursement.
2. Demonstrates competence in the performance of duties and responsibilities related to billing requirements and to improving organizational performance.
. Work denials in an organized manner to avoid timely filing adjustments.
a. Post and balance cash via ERA and paper remits in a timely manner.
b. Accurate submission of corrected claims and late charges via medical software systems per payer specific guidelines.
c. Accurately correct/change patient insurance information in the billing system.
d. Daily clearing of claim edits and rejections in clearing house.
e. Obtains medical records from current operating systems in order to complete requests by insurance companies and/or legal entities.
f. Documents all actions in all current operating systems.
g. Confident leader with the ability to independently resolve claim issues utilizing available resources.
h. Ability to submit effective appeals according to payer specific guidelines.
i. Ability to follow authorization denial workflow.
j. Review credit balances to determine appropriate action according to WDH Credit Balance Policy.
k. Ability to correctly submit secondary claims per payer specific guidelines.
l. Participates in the training of new staff.
3. Allow for professional growth and maintain positive work relationships.
. Demonstrates successful team leadership by providing direction, focus, control and effectively facilitating achievement of team goals.
a. Demonstrates a positive work ethic, attitude and willingness to participate within a team.
b. Provides effective mentoring/training and serves as the departmental expert for the assigned specialty.
c. Responsible for active and on-going quality assurance and process improvement initiatives within the department in conjunction with department manager/supervisor.
d. Continues to expand professional growth by recognizing current trends and preparing to meet challenges.
e. Enhances professional growth through educational programs, workshops, and billing related meetings.
f. Participates in all staff meetings.
g. Requires minimal direct supervision and functions independently within a team environment.
h. Ability to perform as a resource to ancillary departments.
Experience Minimum Required
• 18 months billing, customer service, and banking or related insurance expertise.
Education Minimum Required
• High School and Office Practice Courses, 2-3 years Computer Applications Experience
Special Skills Minimum Required
• Accuracy in typing minimum 35 WPM; computer manipulation; proficient with Microsoft Office, Attention to detail and excellent customer service skills.
• Familiarity with research methods and information sources, especially reliable web-based sources of information.
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