Description

Responsible for 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. Reviews and resolves billing edits in EPIC and in claims scrubber system. Verifies accuracy of claims submitted to payers. Claims process includes reconciling claim runs, creating electronic claim files, and resolving errors. Resolve claims editing issues and interact with third party clearinghouse or the claims scrubber vendor to produce clean claims. Identifies recurring billing errors and trends and reports 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. Identify and document ongoing payer issues and forward them to supervisor as needed. Review and correct claims in error status thru online systems (FSS0). Utilize online eligibility systems including EPIC (Real Time Eligibility), Passport, MECA, Provider One and One Health Port to determine correct eligibility. Write and submit appeals, including necessary supporting documentation. Update patient's insurance date in EPIC as require or appropriate. Follow established Billing Office guidelines for adjustments to accounts and forward to appropriate work queues when required. Answer phone inquiries from patients and insurance regarding bills, charges and account status.

Stay informed of new and/or changing regulations as well as payer policy time limits, and incorporates updates into daily operations. May be required to participate in internal and external audits, review audit findings and implements changes as required. Resolves issues holding up timely claim payment, including requests for medical records, coordination with Customer Service and other related departments.

Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Join our team at SWEDISH HEALTH SERVICES where you’ll support nurses both in and out of surgery, among other patient care tasks. As a Providence caregiver, you’ll apply your specialized training to deliver world-class health with human connection and make a difference every day through your extraordinary care.

Required Qualifications:

• Coursework/Training Medical terminology and medical coding training in an accredited school. Or equivalent educ/experience.
• 1 year Experience in hospital insurance regulatory billing, including Medicare, Medicaid and / or Labor & Industries (L&I).

Preferred Qualifications:

• Bachelor's Degree Finance, Business Management or health care administration.
• A strong technical background including experience with automated systems.
• Experience working with Provider One, MECA, FSS0 and/or CWF.

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Swedish is the largest not-for-profit health care system in the greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Swedish Medical Group, a network of more than 128 primary care and specialty care locations throughout the Puget Sound. Swedish, named a LinkedIn Top Company to grow your career, employs nearly 13,000 caregivers (all employees), including nearly 1,400 providers. Whether through physician clinics, education, research and innovation or other outreach, we're committed to caring for the people in our region and beyond.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 181216

Company: Swedish Jobs

Job Category: Patient Financial Services

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 3900 SS Billing Office

Address: WA Seattle 747 Broadway

Pay Range: $27.33 - $40.80

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

Swedish Health Services is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.