Swedish Medical Center is looking for a Business Office Regulatory Specialist \(1\.0 FTE, Day Shift\) to work for the Billing Office at the Metropolitan Park East Building in Seattle, WA\.
The Business Office Regulatory Specialist is responsible for the preparation, editing and submission of accurate and timely insurance claims \(electronic and manual\) to regulatory payers \(including Medicare, Medicaid, L&I, VA, Crime Victims & Healthy Options\), for primary, secondary, late charge and corrected claims\.
In this position you will:
- Review and resolve billing edits in EPIC and in claims scrubber system
- Verify accuracy of claims submitted to payers
- Reconcile claim runs, create electronic claim files, and resolve errors
- Resolve claims editing issues and interact with third party clearinghouse or the claims scrubber vendor to produce clean claims
- Identify recurring billing errors and trends and report them to supervisor when necessary
- Conduct research / analyze coding errors, document billing issues / trends, and assist with problem solving and solutions
- Process credit balances due to regulatory payers
- Proactively collect active outstanding A/R from regulatory payers
- Contact insurance payers by either phone or online inquiry regarding unpaid hospital claims
- Review remaining balances on accounts after insurances have paid to determine appropriate next action
- Review denials by regulatory payers for entire claims or line items to determine if additional follow up is needed or assistance from other internal departments and forward to them as needed
Required qualifications for this position include:
- Minimum one year experience in hospital insurance regulatory billing, including Medicare, Medicaid and / or Labor & Industries \(L&I\)
- Medical terminology and medical coding training in an accredited school or equivalent on\-the\-job training in a billing role
- Knowledge of the revenue cycle and/or regulatory requirements as they relate to the hospital and professional billing and collections for third party insurance payers
- Detailed knowledge and understanding of ICD\-9, CPT, and HCPCS coding classification systems, familiar with medical terminology and its applications, insurance rules and regulations
Preferred qualifications for this position include:
- Bachelor's degree in Finance, Business Management or health care administration
- Strong technical background including experience with automated systems
- Experience working with Provider One, MECA, FSS0 and/or CWF
- Proficient in working with Epic
About Swedish Shared Services
Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area\. Our expanding network of facilities currently includes three hospital locations in Seattle, a hospital in Edmonds and the new Swedish Issaquah campus\. It also consists of Swedish Medical Group's network of primary care clinics, and affiliations with suburban hospitals and specialty clinics throughout Greater Seattle\.
Each campus has a local operations leadership team, supported by centrally located and led corporate services, such as Human Resources, Financial and Information Services\.
We offer a full comprehensive range of benefits — see our website for details
Our Non\-Profit Mission: Improve the health and well\-being of each person we serve\.
Since 1910, Swedish has been a hallmark of excellence\. Swedish has grown to become the largest non\-profit health provider in the Greater Seattle area with 11,000 employees, more than 2,800 physicians and 1,700 volunteers\. Swedish is committed to being the best place to receive care, and also the best place to work\. We reward our employees with generous compensation and benefits, individualized orientation, education and a supportive work environment\. Swedish is proud to be an Equal Opportunity Employer\. Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law\.
Job Category: Billing / Insurance
Req ID: 144826