Shriners Children’s is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

All employees are eligible for medical, dental and vision coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a full-time or part-time status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans. Additional benefits available to full-time and part-time employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

The Hospital Billing Lead is responsible for overseeing the billing team and daily operational activities. Routinely monitors daily claim workload and assigns claims to the billing staff as needed. The Lead is to assist the manager in ensuring the employees are accurately completing their assigned duties in a timely manner and in accordance with department policy. The Hospital Billing Lead will analyze pre-billing rejections, as well as billing denials data. This position will ensure timely resolution of accounts receivable by researching accounts, refiling or appealing claims, submitting additional medical documentation, and tracking account status by monitoring and analyzing unresolved balances, to ensure continuity of cash flow.

• Oversee the hospital billing team to ensure accurate billing and timely claims submission of electronic and hard copy claims
  • Monitor all claim workqueues to ensure they are fully resolved in a timely manner.
  • Assist manager in ensuring the employees are accurately completing their assigned duties in a timely manner and in accordance with department policy
  • Communicate/escalate potential claims/unbilled accounts/issues to the manager
• Provide training for new or existing billing staff on systems and procedures updates
• Ensure accurate processing of claims in a manner that is consistent with industry standards, regulations, and SHC policies and procedures.
• Analyze rejected and denied claims
  • Use problem solving skills to determine root cause and escalate trends to management
• Prioritize activities to alleviate untimely filing denials
• Document all communications with payers, as well as all billing activities, on the patient’s account with clear, concise, and accurate comments
• Lead projects and initiatives.
  • Conduct research for payer criteria, and prepare documents for resubmission or special projects
• Research, verify, and take appropriate actions as it relates to all pre-billing adjustments
• Consistently seek improvement in processes and procedures for all billing and reimbursement functions, to include problems with workflow, and billing issues.
  • Escalate possible process improvement initiatives to management
• Build and maintain relationships with payer representatives
• Crosstrain in multiple areas, as well as perform all other duties as assigned

This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Required:

• 3-5 years of experience in medical billing, claims’ processing and follow-up, to include all EDI Transaction sets, UB04 and 1500 claim forms
• Possess expert knowledge in federal, state and third-party claims’ processing practices
• Maintain expertise regarding CCI edits, HCPCS, ICD-10, and Revenue Codes
• High School Diploma/GED

Preferred:

• Epic experience
• Bachelor's Degree, or equivalent combination of education, and training and experience