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Billings Clinic Claims Specialist - CBO in Billings, Montana

Job Description:

You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet? Recognition consecutively since 2006.

And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!

You can make a difference here.

About Us

Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.

Your Benefits

We provide a comprehensive and competitive benefits package to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with
emplo
yer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more. Click here for more information or download the 2021 Employee Benefits Guide.

Magnet: Commitment to Nursing Excellence

Billings Clinic is proud to be recognized for nursing excellence as a Magnet?-d
esignate
d organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here to learn more!

Claims Specialist - CBO

PATIENT FINANCIAL SERVICES (Billings Clinic Main Campus)

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Shift: Day

Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours (Non-Exempt)
Starting Wage DOE: 15.00 - 17.64

The Claim Specialist’s main focus is to obtain maximum and
appropriat
e reimbursement for all claims from government and third-party payers. The Claims Specialist is responsible for preparing and submitting timely and accurate insurance claims to government and third-party payers, assisting in the implementation of payer regulations and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract or other regulations or agreements. The Claims Specialist is responsible for appropriate follow up on all accounts pending payment from government and third-party payers.

Essential Job Functions

• Sup
ports and mo
dels behaviors consistent with the mission and philosophy of Billings Clinic and department/service.

• Responsible for submission of timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission. Generates telephone calls to insurance carriers to follow up on insurance using reports generated for this purpose to ensure the timely collection of money due on the account.

• Audits accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance responsibility to patient responsibility when appropriate, and reviews and res
olves credit b
alances.

• Ensure that claims have appropriate information on them for submission to insurance companies or agencies by reviewing errors and other prebilling insurance reports/worklists. Analyzes and review claims to ensure that payer specific regulations and requirements are met.

• Prepares and presents verbally and in writing challenges to third party payers for additional reimbursement for denied charges and/or reductions in reimbursement as appropriate.

• Provides guidance and or assistance to the cashiers.

• Provides timely follow-up on correspondence received from the insurance carrier or patient.

• Responds to inquiries from customers/other departments/insurance carriers regarding insurance coverage issues, coordination of benefits, reconciliation of account balances and complaints regarding services received. Initiates appropriate follow-up on outstanding issues.

• Sets up registration and insurance information when necessary.

• Utilizes performance improvement principles to assess and improve quality.

yle="color: black;
font-size: 10pt; font-family: Arial, sans-serif;">• Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.

• Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.

• Performs other duties as assigned or needed to meet the needs of the department/organization.

Knowledge, Skills, and Abilities

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bsp; &nbs
p;

• Billings Clinic policy and procedures, both organizational and departmental

• Billings Clinic Code of Business Conduct

• Billings Clinic Corporate Compliance Program

• Personal computers, hardware and software & printers


HIPAA and confidentia
lity requirements

• Patient’s/resident’s rights

• Medical terminology

• Customer service techniques and Personal Service Excellence (PSE) skills

• Office procedures, record and bookkeeping practices

• Third party insurance reimbursement methodology and billing requirements

• Basic collection procedures

• Professional communication skills, both verbal and written

• Basic typing at 45 WPM with accuracy

• Basic ten key

• Basic computer

• Time management, organization and prioritization

yle="color: black; font-si
ze: 10pt; font-family: Arial, sans-serif;">• Interpersonal relationships

• Incorporate population specific needs into all aspects of communication and patient care

• Communicate clearly and effectively, both verbal and written

• Establish and maintain collaborative relationships

• Work effectively in a team environment

Ȃ
2; Work independently with m
inimal supervision

• Remain organized and focused when dealing with frequent interruptions and competing priorities

• Respond calmly and effectively to sensitive and difficult situations

• Concentrate and pay close attention to details

• Utilize time management concepts and maximize time effectively

• Maintain flexibility t
o adapt to a variety of work l
oad assignments

• Interpret policies and procedures, identify non-compliance and take appropriate action

• Work with numbers and perform basic to complex mathematics

• Analyze accounts and compare to contracts, agreements and government regulations.

• Position requires high degree of confidentiality due to access of financial and medical information

• C
omplexity of duties comes in understanding the policies and procedures, which change with great frequency, to make independent decisions that will not jeopardize the collect ability or amount received by Billings Clinic and for prioritizing the work volumes appropriately.

• Concentration on organization since this position handles a large volume of paper work.

• Concentration on detail when dealing with numbers and mathematical calculations where errors are critical to our customers and our business.

• A complete understanding of Billings Clinic charges, billing structures
and the rationale behind them so
appropriate answers can be given to the customer, public, and third parties.

• A thorough understanding of the laws governing authorized signatures, release of information, and release of diagnosis, disclosure regulation and billing and collection authority.

• Concentration as the job requires high productivity yet has many and frequent interruption factors including telephone calls.

• A thorough understanding of contracts, arrangements, agreements and government regulations that govern insurance claims to ensure compliance and proper reimbursement.

"color: black; font-size: 10pt; font-family: Arial, sans-serif;">• Errors are costly to Billings Clinic to the extent of financial loss and damaging customer’s attitude toward the facility.

Minimum Qualifications

Education

• High School or GED

Experience

• One year of previous office experience


Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community membe
rs, nurses and physicians. Billings Clin
ic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at www.billingsclinic.com/aboutus

Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and j
ob applicants. Employees are encouraged to
discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.

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