Billing Specialist

BILLING SPECIALIST

SUMMARY: Process patient and insurance billing payment for services rendered. Provides support in all areas of the billing department.

ESSENTIAL DUTIES AND RESPONSIBILITIES: includes the following, other duties may be assigned.

1. Charges and payments
   1. Downloads weekly scheduled Medicaid and corrects denials.
   2. Enters all hospital encounters.
   3. Posts payments from Medicare and Medicaid electronically from weekly schedules onto patient accounts.
   4. Investigates and/or correct patient bills submitted from LabCorp and serves as backup for monthly billing of LabCorp
2. Research and resolve client insurance claims which are denied or uncollected.
   1. Correcting and/or resubmitting claims denied by various payers, including insurance, HMO, Medicaid, Medicare and private pay.
   2. Transmits electronically to check and correct errors and previously transmitted kickback errors.
3. Answers and resolves billing issues
   1. Communicate with patients and/or insurance companies.
   2. Work with the clinical staff members to resolve billing problems.
   3. Performs backup support for printing medical and dental claims.
   4. Back-up to add or update insurance company, CPT Codes, diagnosis codes and referring provider profiles as needed
4. Refunds
   1. Initiates check request for patient refunds as needed.
   2. Processes insurance companies' refunds/take backs as needed.
   3. Processes bad debt payments as needed.
5. Responsible for daily balancing.
   1. Close daily journals
   2. Receiving and balancing monies from all sites and incoming mail on a daily basis.
   3. Prepares banking slips for daily deposit.
   4. Run daily basis general ledger (GL), batch, no batch, and error reports
   5. Completes Excel spreadsheets to track Electronic Funds Transfers (EFT), miscellaneous cash and overages/shortages from sites.
6. Ensure patient confidentiality and EMR security at all times.
   1. Maintain patient information within HIPAA guidelines.
7. Keep other Care Team Members informed when situations occur that disrupts timely patient flow through site.
8. Consistently participates in and actively adheres to patient care expectations to attain clinical goals set forth in the PCHG Health Care Plans and the Quality Improvement / Quality Assurance (QI/QA)

SUPERVISORY RESPONSIBILITIES: None

GENERAL DEVELOPMENT:

1. Maintains a professional relationship and positive attitude with co-workers, the public, patients and the entire organization.
2. Maintains the highest professional and work ethics.
3. Displays enthusiasm toward the work, mission and vision of the organization.

PROFESSIONAL KNOWLEDGE, SKILLS AND ABILITES:

1. High School Diploma or GED.
2. Basic understanding of medical terminology and documentation.
3. Ability to use basic mathematical skills.
4. Able to perform repetitive tasks.

COMMUNICATIONS SKILLS:

1. Exceptional Customer Service skills.
2. Ability to communicate effectively, verbally and in writing.
3. Excellent grammar, spelling and interpersonal skills.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to lift 20 lbs. regularly and 30 lbs.-50 lbs. occasionally.
2. Ability to sit for long periods of time.
3. Direct exposure to computer screen.
4. May be exposed to contagious/infectious diseases.

Salary : $0