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Bozeman Health Insurance Claim Billing Specialist in Bozeman, Montana

Position Summary:

The Insurance Claim Billing Specialist’s main focus is to obtain maximum and appropriate reimbursement for all claims from third party payers. Prepares and submits timely and accurate insurance claims to 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. Responsible for appropriate follow up on all accounts pending payment from government and third-party payers.

Minimum Qualifications:

  • High School Diploma or Equivalent

  • One year of office experience

  • Preferred: Completion of program in medical billing degree or certification program

  • Preferred: Two years of healthcare clinic/hospital billing experience

Essential Job Functions:

  • Submits 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 claims using electronic worklist and reports generated for this purpose. Follows up on all unpaid claims through phone contact or written correspondence to ensure that no account reaches 180 days old from discharge date and still due by insurance.

  • 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 resolves credit balances

  • Ensures 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.

  • Helps Customer Service with patients billing questions regarding medical bills and help resolve in any way that is satisfactory to the patient.

  • Fixes claims that contain errors based upon why the claim is not paid.

  • Communicates with Billing Supervisor, Director, Denial Mgt. Coordinator, Coding Supervisor and Compliance Officer regarding claim errors to reduce problems in the future.

Knowledge, Skills and Abilities

  • Demonstrates sound judgement, patience, and maintains a professional demeanor at all times

  • Ability to work in a busy and stressful environment

  • Creativity, problem analysis and decision making

  • Ability to work varied shifts

  • Exercises tact, discretion, sensitivity and maintains confidentiality

  • Computer applications, MS Office, EMR, internet applications and standard office equipment

  • Ability to analyze, organize and prioritize work while meeting multiple deadlines

  • Self-directed, completes assignments accurately, thoroughly and with minimal oversight

  • Detail oriented, organizational skills and the ability to prioritize

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified.

77211370 Patient Financial Services

Working at Bozeman Health is more than just a job--it's a commitment to caring for the communities of Southwest Montana by being their partner in health and wellness, compassionately delivering the best care for each person, every time. In every role, our employees are inspired by their ability to care for our community and our Culture of Excellence guides each employee to be a high performer, engage in transparent and timely communication, demonstrate dynamic learning and teaching, excel through change, express gratitude and experience joy.