Claims and Billing Specialist – Business Office | Full Time

Holly Thompson

Why Blue Mountain Hospital District & Grant County?

The Blue Mountain Hospital District (BMHD) is located in Grant County, Oregon, at the heart of the John Day River, in beautiful, rural, Eastern Oregon.  Our District is comprised of a Critical Access Hospital (CAH), Family & Rural Medicine Clinic, Home Health and Hospice, Emergency Medical Services, an Intermediate Care Center and all of the supporting ancillary departments necessary to care for the health and wellness of our community.

Our District spans from John Day to Prairie City, nestled in a valley surrounded by the Blue Mountains.  The Strawberry Mountain Range and John Day River Valley offers a variety of outdoor activities, from abundant hiking/mountain biking/horse riding trails, to high and low lakes and ponds.  Our area is known to be a “go to” place not just for recreation, but also for big game hunting and fishing!

Join our family-like team and settle into a lifestyle that is hard to beat!

For more information on our area, visit our Grant County Chamber of Commerce page at: https://www.gcoregonlive.com/

Job Summary: 

The Claims and Billing Specialist is responsible for the day to day submission of technical or professional medical claims to insurance companies electronically and the submission by paper to other payers, ensuring the submission of claims is met in a timely manner. Has an advanced knowledge of billing guidelines including Federal and State insurances and stays informed of changes within those systems, including Medicare and Medicaid and Advantage plans.  The Claims and Billing Specialist is naturally helpful and willing to work a problem to its successful conclusion. Has the ability to communicate effectively with insurance companies, patients, and co-workers. Works with members of the healthcare team to assure collaborative approach is maintained in care and of the patient accounts and information.  Multi-tasking, self-motivation, organization skills, and being able to work in a fast-paced production-oriented environment are required. Actively participates in the department’s performance improvement and continuous quality improvement (CQI) activities. 

Essential Functions and Responsibilities:

  • Promotes the mission, vision and values of the BMHD.
  • Review patient bills for accuracy and completeness and obtain any missing information.
  • Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
  • Knowledge of insurance guidelines, including HMO/PPO, Medicare and State Medicaid.
  • Reports denials on the QA Report for Medicare denied claims and takes appropriate action.
  • Problem solving skills to research and resolve discrepancies, denials, appeals, collections.
  • Reports errors on the QA Admit Error spreadsheet and takes appropriate action.
  • Medicare Credit Balance Report – Quarterly.
  • Medicare Secondary Payer billing
  • Works claims timely keeping A/R aging current.
  • Follow up on unpaid Medicare claims within DDE system.
  • Shadow billing Medicare Managed care IP and SW claims to Medicare.
  • Knowledge of medical terminology likely to be encountered in medical claims.
  • Types required documents and correspondence.
  • Organizes and maintains client records and company files.
  • Complies with all applicable company policies and procedures.
  • Communicates appropriately and clearly to the Business Office Manager, CFO, administrative staff and co-workers.
  • Demonstrates the ability to be flexible and organized in stressful situations.
  • Excellent customer service skills and phone manner.
  • Manages and operates equipment safely and correctly.
  • Any additional duties pertaining to the daily operations of the revenue cycle.

Core Accountbilities:

Productivity

Demonstrate ability to maintain a high level of output without sacrificing quality.

  • Able to demonstrate and maintain consistent and efficient performance.
  • Able to work with small products with repetitive motion and dexterity required.
  • Ability to manage multiple and simultaneous responsibilities and to prioritize schedule of work.
  • Demonstrate ability to maintain a high level of output without sacrificing quality.
  • Ability to complete work assignments accurately and in a timely manner.
  • Completes annual education requirements.

Technical Skills

Demonstrate ability to learn and maintain appropriate technical skills to effectively support the electronic record system.

  • Displays a thorough understanding of electronic medical records and automated dispensing as relevant.
  • Displays an understanding of the facility’s learning management system and keeping required education up to date.
  • Ability to communicate effectively, both oral and written through e-mail, presentations, etc.
  • Displays understanding of electronic healthcare systems.
  • Proficiency with Microsoft Google Calendar, Gmail, Excel, PowerPoint, keyboarding and reporting.
  • Completes orientation skills checklist assigned for departments

Teamwork

Establish & maintain solid work relationships, through communication, cooperation, and positive interaction with all employees, staff and physicians.

  • Approachability – build rapport by making the effort to be cooperative and adaptive, put others at ease, and support co-workers.
  • Listening – practice active listening; display patience when listening to the views of others, and discuss differing opinions with an open mind.
  • Problem Solving work with others to prevent problems & find a solution when issues arise.
  • Staff Meetings – Expected to attend departmental staff meetings and other meetings as required by administration.

Customer Service

Exhibit professional behavior while being caring and compassionate.

  • Customer Focusdedicated to meeting the expectations of the internal customer. Demonstrate sensitivity, empathy, concern and respect for others.  Act with the patient care in mind, gain trust and respect by building and maintaining effective relationships.
  • Maintain confidentialityin accordance with hospital and HIPAA regulations.
  • Demonstrate sensitivity, empathy, concern and respect for others. Act with the patient care in mind. Gain trust and respect by building and maintain effective relationships.
  • Represents the organization in a positive and professional manner at all times.
  • Presents a neat and professional appearance.
  • Establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors, and other health care industry personnel.

Effective Use of Resources

Maximize the resources while minimizing waste and controlling expenses.  This includes the effective use of work time and supplies, working safely, following established work practices, and seeking ways to improve operations.

  • Improvement – recommend procedures that reduce costs and streamline operations while improving quality.
  • Maintain neat, clean and professional work area.

Initiative

Self motivated and contribute to new ideas.

  • Improvements – initiate improvements and apply new methods of working to help achieve goals.
  • Learning on the go develop an action plan when facing new problems, and be open to change.

Knowledge, Skills and Abilities:

  • Maintains self-motivation and sustains a high level of momentum.
  • Able to successfully prioritize when faced with requests, demands and deadlines.
  • Knowledge of customer service concepts.
  • Must be extremely detail oriented and able to perform accurate and thorough recordkeeping.
  • Ability to communicate effectively in English, both verbally and in writing.
  • Proven ability to work as part of a team, in a fast-paced production-oriented environment.
  • Ability to prioritize, highly organized.
  • Ensure patient confidentiality.
  • High work ethic, Low Absenteeism, attends staff meetings and other mandatory trainings as required.

Supervisory Responsibilities:

  • None

Supervised by:

  • Business Office Manager

Education Requirements:

Required:   High School diploma

Preferred:   Medical Terminology Course. Clerical and office experience in hospital or healthcare environment. Working knowledge of medical terminology, release of information, electronic medical records and electronic systems.

Certification/Licensure Requirements:

Required:   Basic computer knowledge

Preferred:   Medical Terminology. Basic Life Support (BLS) certified by American Heart Association (AHA).