Billing Specialist

Responsible for ensuring claims are billed correctly, researching claim denials, ensuring correct payments are received, submitting claims, and following up with insurance companies by performing the following duties.

Duties and Responsibilities include the following.  Other duties may be assigned.

1. Reviews claims, claim denials, and payments for accuracy.
2. Identifies claim errors and researches for cause of errors.
3. Communicates with insurance companies when necessary to resolve claim issues.
4. Communicates identified internal errors to appropriate parties in effort to educate and eliminate future errors.
5. Prepares and submits clean claims to various insurance companies either electronically or by paper.
6. Answers questions from patients, clinic staff, and insurance companies.
7. Identifies and resolves billing complaints.
8. Preforms various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
9. Processes credit card payments received in the mail from patients and insurance companies.
10. Provides Athena with copies of deposits and remits for patient and insurance payments received in the mail.
11. Participates in educational activities.
12. Conducts self in accordance with Genesis PrimeCare's employee manual.
13. Maintains strictest confidentiality; adheres to all Health Insurance Portability and Accountability Act guidelines/regulations.
14. Assists the Billing Coordinator as needed.
15. Makes written and oral reports to the billing coordinator and chief financial officer concerning billing functions.
16. Performs other related duties as assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  

Language Ability:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Math Ability:

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.

Reasoning Ability:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft Word, Microsoft Excel, Internet Explorer, Microsoft Outlook, Athena, MicroMD, and Dentrix. 

Education/Experience:

High school diploma or general education degree (GED); and two to four years related experience and/or training; or equivalent combination of education and experience.

Knowledge, Skills and Other Abilities:

• Knowledge of medical billing/collection practices
• Knowledge of basic medical coding and third-party operating procedures and practices
• Typing
• Oral communication skills
• Written communication skills
• Reading skills
• Comprehension skills
• Customer Service
• Organization
• Detail Oriented
• Professionalism
• Time Management

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

While performing the duties of this job, the employee is regularly required to stand, walk, sit, use hands, reach with hands and arms, and talk or hear. The employee is not required to climb or balance and stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 20 pounds, including paper or other regular office items. Specific vision abilities required by this job include close vision. 

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job: The noise level in the work environment is usually mild.  Ability to handle significant stress.

The above information is intended to describe the most important aspects of the job. It is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required in order to perform the work. The health center reserves the right to revise or change job duties and responsibilities as the business need arises. Additionally, this job description is not intended as an employment contract, implied or otherwise, and the Center continues to maintain its status as an at-will employer.