Billing Specialist I at Nemours in Wilmington, Delaware

Job Description:

This position is responsible for: performing assigned duties of a hospital billing specialist at AIDHC. Ensures "front end" hospital billing claim is complete and accurate according to regulatory guidelines. Works with insurance companies, charge capture departments, CDM Manager, recovery Auditors, coding/billing integrity, and central billing office.

Essential Functions

1. Reviews, monitors and completes hospital claims for all elements of the UBO4 billing form according to CMS and specific payor guidelines.

2. Reviews daily DNB (Discharged Not Final Billed) accounts within assigned workqueue(s).

3. Works closely with CDM Manager and Central Billing Office to ensure all related charges errors are corrected and reported for needed process improvement.

4. Performs specialty billing for Medicare End Stage Renal Disease patients.

5. Works closely with Transport department and completes charge capture for Nemours Transport services.

6. Assists in SP collections recovery, by calling guarantors and verifying insurance benefits.

7. Assists Recovery Audit staff with all claim submission inquiries and reimbursement explanation of benefit data.

8. Conducts research related to hospital billing issues using various types of information media: internet, payor intranet, payor newsletters and/or manuals.

9. Provides support to scheduling and registration departments with patient coverage, eligibility and authorizations.

10. Works assigned claim edit workqueues correcting all errors and warnings to ensure first-time claim accuracy.

Requirements:

• CRCS-I certification within 12 months
• 1-3 years related experience
• High school diploma