Pittsburgh, Pennsylvania

**Company :**

Allegheny Health Network

**Job Description :**

GENERAL OVERVIEW:

This job processes pro-fee billing activities.

ESSENTIAL RESPONSIBILITIES:

+ Posts co-payments, patient payments, and insurance company payments (paper and electronic), and denials. Performs reconciliation of payments. Prepares and deposits payments received. (25%)

+ Uses CPT, ICD-9, and payer specific codes and modifiers to prepare and enter charges for entry (includes office, hospital, and outpatient charges). (20%)

+ Assists customers with patient billing inquiries. Identifies unpaid balances (insurance and patient) through A/R reports and takes appropriate actions. (25%)

+ Obtains and enters patient demographic, insurance, and referral/precertification information in the billing system. (10%)

+ Verifies insurance information via hospital and insurance carrier systems. Ensures that electronic and paper claims are sent to insurance carriers in a timely manner. (10%)

+ Maintains current knowledge of federal and state reimbursement policies/regulations and system policies pertaining to billing. Ensures compliance with regulatory requirements. (10%)

+ Performs all other duties as assigned, including but not limited to supporting front end office processes.

QUALIFICATIONS:

Minimum

+ High school diploma or GED; or one to three months related experience and/or training; or equivalent combination of education and experience.

+ 1-3 years’ healthcare billing experience.

Preferred

+ Graduate of a medical billing program.

+ Medical Records training and OASIS education.

**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._

**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._

_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._

_Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity ( http://www1.eeoc.gov/employers/upload/eeoc\_self\_print\_poster.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J178168

Pittsburgh, Pennsylvania

Invest in yourself by becoming part of the Highmark Health enterprise! Build and grow your career with the tools and resources you need to be successful in our innovative and transformational environment. From new hire training to advanced education opportunities, career planning is a continuous journey that leads to your personal and professional growth and our success.

Whether your focus is nursing, information technology, actuarial, finance, marketing, sales, operations or one of our many other professions, our companies offer opportunities to develop and expand your career while making health care accessible, understandable and affordable for our millions of members, patients and customers.

Similar jobs