Billing Specialist

Summary: The primary function of this position is to prepare and submit claims and statements to third-party payers and guarantors. Responsible for maintaining accounts receivables and Performing all Verification of Benefits and prior Authorization/Pre-certifications confirmations

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

• Verify all patient insurance benefits and confirm if prior authorizations are required. Also confirm that authorizations obtained by the physician cover all services that will be performed at the ASC
• Complete the patient estimates in HST and contact patients with patient responsibility for DOS.
• Process claims daily, provide all required attachments as appropriate

• Submits all primary, secondary, and tertiary claims electronically to the clearinghouse
• Corrects unbilled claim edits as appropriate to ensure claims final bill
• Understands and abides by billing compliance regulations
• Verifies accuracy of insurance payments, post payments, and adjustments per EOBs and payer contracts specifically for the ASC.
• Runs reports on outstanding insurance A/R on a daily/weekly basis
• Follow-up on insurance claims within 30 days of billing for commercial, 21 days for government payers
• Respond to all billing related inquiries
• Interact with patients when required to bring account to closure
• Print and mail patient statements on a monthly basis
• Runs reports on outstanding patient A/R on a weekly basis. Patient account balances of more than 90 days with no payment will be reviewed with manager and turned over to collections
• Sends approved accounts to collection agency, monitors collection agency
• Submit refund requests with supporting documentation to manager
• Assists and backs up other business office positions as needed
• Answers telephone, questions, and returns calls in a courteous timely manner
• Performs additional duties as assigned or requested

OSHA Exposure Classification:

Job Category III. Tasks/activities presents an unlikely occurrence of exposure to infectious materials.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Reasoning Ability:

A candidate must have the ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form as well as the ability to deal with problems involving several concrete variables in standardized situations. This individual must have strong verbal and written communication skills and be able to communicate effectively.

Computer Skills:

To perform this job successfully, an individual should be proficient at working with computers and Microsoft Excel and Word software. Experience working with patient financial systems, specifically ASC patient financial systems preferred.

Certificates and Licenses:

• N/A

Education/Experience:

• High school diploma or GED certificate
• Minimum of 1 year billing experience required
• Minimum of 1 year accounts receivables required