BILLING SPECIALIST

Description

SUMMARY:

The Billing Specialist is responsible for billing paper and electronic claims for primary and secondary payers. Completes timely and accurate billing for designated payer class ensuring all claims are submitted on the same day of receipt. Monitors outstanding accounts and applies late charges. Receives and answers billing-related inquires and prepares daily billing activity and balancing reports.

DUTIES AND RESPONSIBILITIES:

• Submit reimbursement requests to Medicare and Medicaid and process insurance claims for private and employer insurance reimbursement
• Work with patients to develop self-pay arrangements and payment plans
• Ensure medical data is secure, accessible and accurate for billing and reimbursement for all services
• Develop Standard Operating Procedures to ensure controls are in place to comply with regulations and best practices in managing cash and receipts
• Process and follow up on payer denials, consulting with the patient and/or his or her family as needed
• Obtain insurance referrals, pre-authorizations and verification as it relates to denied claims
• Post payments in a timely manner
• Initiate private pay collections after insurance cancellation, denial or other issue
• Research and resolve client billing problems or issues
• Assist patients and their families with applying for CareCredit and other financial solutions
• Document payment records and issues as they occur
• Maintaining a comprehensive knowledge of contemporary health record and coding practices
• Works closely with the billing director, center managers, team leaders, and corporate medical director to ensure all processes are streamlined to minimize disruption in patient care while maximizing reimbursement
• Answers questions from patients, staff and insurance companies
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
• Maintains strictest confidentially; adheres to all HIPAA guidelines/ regulations
• Other duties and responsibilities may apply as the position evolves
• Must have a clear understanding of company policies including the company manual

Requirements

KNOWLEDGE, SKILLS, AND ABILITIES:

• Exceptional Customer Experience – Understands and anticipates customer needs, takes action to meet customer’s needs. Strives to exceed customer expectations
• Proactive- Keep others informed. Ask for help when needed, brings service challenges to supervisor
• Drive for Results – Strives for improving the delivery of services with a commitment to continuous improvement
• Focus on Efficiency – Utilizes technology, innovation, and process improvements to continuously improve efficiency and effectiveness
• Teamwork- Participates as a team member and establishes strong working relationships with teammates and across the organization
• Celebrates Change- Receptive to new ideas and responds to changes with flexibility and optimism.
• Continues Learning and Improvement- Acknowledges own strengths and development needs and works to strengthen capabilities
• Must be well organized and detail oriented.
• Ambitious attitude.
• Knowledge of insurance rules and denial codes.
• Knowledge of business office procedures.
• Skill in answering telephone in a pleasant and helpful manner.

EDUCATION:

• Associates’ degree plus a minimum of 2 – 5 years’ experience in billing, collections, or insurance verification

TYPICAL PHYSICAL DEMANDS:

• Sitting, Standing, Bending, Reaching, Stooping, Walking and Lifting
• Ability to see, hear, and speak with sufficient capability to perform assigned tasks
• Driving independently to other facilities
• Ability to use keyboard
• Ability to use electronic medical record and scheduling software

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be construed as an exhaustive list of all duties to be performed.