Job Summary

The Billing Specialist is responsible for managing the billing process, ensuring the accurate and timely submission of insurance claims. This role oversees claim edits and DNB (Do Not Bill) holds to guarantee that claims are submitted correctly and promptly, minimizing denials and ensuring optimal revenue collection. Under the direction of the Director, Patient Accounts, performs functions involved in the billing and collection of hospital receivables, customer service duties, the processing and reconciliation of various charge-entry, edit and error reports. Has a diverse knowledge of Patient Accounts follow up techniques and is familiar with a wide variety of payers, such as Managed Care, Self Pay, and Auto. Is consistent, dependable and accurate in carrying out responsibilities to a successful conclusion. Clearly understands purpose, objectives practices and procedures of the department. Performs other tasks that may be assigned by the Manager. Responsible for performing job duties in accordance with mission, vision and values of Tampa General Healthcare.

Essential Duties:



- Prepare and submit accurate and timely insurance claims to payers.

- Review and resolve claim edits and DNB holds to ensure clean claim submissions.

- Monitor claim rejections and denials, and take necessary actions to resolve issues.

- Ensure compliance with payer requirements and regulations.

- Collaborate with the coding and compliance teams to address and rectify billing issues.

- Maintain up-to-date knowledge of billing regulations and payer requirements.

- Generate and review billing reports to identify trends and areas for improvement.

- Communicate with insurance companies to resolve claim issues and discrepancies.

- Assist with training and mentoring new billing staff.

- Participate in continuous improvement initiatives to enhance the billing process.

Qualifications

• High school graduate or GED; a minimum of three (3) years of Hospital, Physician or Insurance Payer experience in billing and collecting Medicare/Medicaid; working knowledge of Federal, State and County guidelines as it relates to billing; and knowledge of electronic billing systems.