Billing Specialist I

Sterling Health Solutions, Inc.

Job Description

Title: Billing Specialist I

Supervisor(s): Director of Revenue Cycle

Department: Finance

FLSA Status: Non-Exempt

Effective Date: August 18, 2015

Job Summary

Responsible for all facets of medical, vision and/or dental billing and accounts receivable management including charge entry, payment posting, customer service and follow-up in accordance with practice protocol with an emphasis on maximizing patient satisfaction and profitability. Responsible for reviewing the patient demographic information in the practice management system at the time of charge entry to ensure accuracy and to provide feedback to the other front office staff regarding patient registration. Responsible for reviewing the physician’s coding at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. Responsible for submitting insurance claims as required by standard operating procedures. Responsible for providing cross coverage for the Authorization Coordinator, Receptionists as required to ensure efficient and professional practice operations and maximum patient satisfaction.

Duties and Responsibilities (for medical, dental & vision)

• Input all charges into the practice management system including office charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction. All charge batches should balance in both number of procedures and total dollar prior to posting.

• Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines in the Procedure Manual.

• File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference.

• Review the providers coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement.

• Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 1 business day to ensure maximum patient satisfaction.

• Verify all demographic and insurance information in patient registration of the practice management system at the time of charge entry to ensure accuracy, provide feedback to other front office staff members and to ensure timely reimbursement.

• Follow-up on all outstanding insurance claims at 60-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.

• Follow-up on all outstanding patient account balances at 90-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using the A/R aged reports.

• Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians, managers and subordinates.

• Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.

• Submit primary and secondary insurance claims electronically each day and on HCFA semi-weekly to ensure timely reimbursement.

• Recommend accounts for outside collection when internal collection efforts fail in accordance with practice protocol.

• Process refunds to insurance companies and patients in accordance with practice protocol.

• Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.

• Proficiency with all facets of the medical, dental or vision practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.

• Verify all demographic and insurance information in patient registration of the practice management system at the time of charge entry to ensure accuracy, provide feedback to other front office staff members and to ensure timely reimbursement.

• Proficiency with verifying eligibility and claim status information, to efficiently conduct accounts receivable follow-up and to maximize revenue.

• Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format.

• Maintain an organized, efficient and professional work environment.

• Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance.

• Other duties as assigned.

Duties and Responsibilities (for dental)

The Dental Billing Specialist serves as a liaison between the dental providers and the patients to ensure a smooth transition from diagnosis to the completion of the dental treatment. This role involves understanding dental procedures and the ability to communicate effectively with patients about their treatment plans, including costs, scheduling, and any necessary follow-up care. By providing clear information and support, the billing specialist will help patients make informed decisions about their dental health, enhancing their overall experience within the dental practice.

Duties and Responsibilities

• Explain treatment plans and options to patients, ensuring they understand the recommended procedures, associated costs, and available payment plans.

• Conducting daily audits in the practice management system to ensure patient and payer information was accurately entered for all prior day visits.

• Coordinate appointment schedules for patients undergoing multiple treatments, optimizing the use of the dentist's and dental hygienist's time.

• Coordinate with dental insurance companies to verify benefits and obtain pre-authorizations.

• Processing copays/ any time-of-service payments, as well as setting up payment plans in accordance with company policies.
• Review rejected claims daily for correction and resubmission for timely reimbursement.

• Facilitate communication between the dental team, billing department and patients, acting as the primary point of contact for patient inquiries related to treatment plans and scheduling.

Knowledge, Skills and Abilities

Required

• Requires an extensive working knowledge of managed care networks and insurance carriers.
• Requires excellent written and verbal communication skills and strong customer service skills.
• Requires an extensive working knowledge of accounts receivable functions including CPT and ICD-10 coding.
• Requires proficiency in working with a PC, the Internet, and MS Windows.
• Required proficiency in medical and/or vision and dental terminology.

Credentials and Experience

Required

• High school diploma or GED is required.
• Requires a positive attitude with the ability to problem solve and work well with others.
• Requires a high amount of self-initiative and the ability to work independently.

Preferred

• 2-year associates college degree is preferred.
• A minimum of 3 years of accounts receivable experience preferably in a Federally Qualified Health Center (FQHC).
• Previous accounts receivable experience in dental billing software.
• Dental billing experience is preferred, but a willingness to learn and problem solve.
• Certified Professional Coder (CPC) preferred.

Special Requirements

Requires full range of body motion including manual and finger dexterity and eye/hand coordination. Requires sitting, standing and walking for extensive periods of time. Requires working under stressful conditions or working irregular hours. Requires frequent exposure to communicable diseases, body fluids, toxic substances, medicinal preparations and other conditions common to a clinic environment. The employee frequently is required to reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Ability to work with a moderate noise level in the work environment is required.

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.

If the essential functions of this position cannot be performed in a satisfactory manner by the employee, reasonable accommodations may be made.

Signature of Incumbent

I hereby acknowledge that I have read and understand the above-mentioned job duties, qualifications, policies, and procedures for this position. I also certify that I received a copy of this job description.

Incumbent: ____________________________ Date: ________________________