Swedish Medical Center Business Office Regulatory Specialist in Seattle, Washington
Where you work matters! Swedish Medical Center is looking for a FTE Business Office Regulatory Specialist to work at Swedish Met Park East 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-10, 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
Hospital Billing Experience (all other payers besides Medicare & Medicaid 2 years)
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 nonprofit Mission is to improve the health and wellbeing of each person we serve. Our Vision is to demonstrate the highest-quality, best-value healthcare to all we serve.
Swedish is the largest nonprofit health care provider in the greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); ambulatory care centers in Redmond and Mill Creek; and Swedish Medical Group a network of more than 118 primary care and specialty locations throughout the Puget Sound. Swedish employs more than 13,300 employees and 3,100 physicians and allied health professionals. Whether through physician clinics, education, research and innovation or other outreach, we’re committed to caring for the people in our region and beyond. 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
Work Locations: Metropolitan Park East (WA152) 1730 Minor Avenue Metropolitan East Tower Seattle, 98101
Req ID: 203400