Billing Specialist

Billing Specialist

The billing specialist performs a wide variety of duties relating to review, analysis, billing, adjusting, finalizing, and filing of all third-party and private insurance company claims.

The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.

Qualifications

Knowledge, Skills and Abilities:

• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision.
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize.
• Possesses exceptional verbal and written communication skills.
• Possesses independent work habits, is self-reliant and self-directed.
• Ability to learn, adapt, and change as required by the job functions.
• Ability to maintain absolute confidentiality of material and information accessed and reviewed.
• Basic computer literacy.
• Ability to move freely, reach, bend, and complete light lifting.
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines.
• Ability to maintain attendance to meet standard job practices.

Education:

High School Graduate or G.E.D. required.

Licensure:

One year of healthcare experience desired. Requires three to six months on-the-job training to become familiar with billing practices and policies.

Interpersonal skills:

Essential technical/motor skills.

Essential physical requirements:

Light: Exert up to 20 lb. of force occasionally and/or up to 10 lb. of force frequently - greater than 75%.

Essential mental requirements.

Essential sensory requirements.

Other:

Typing skills may be required. Computer experience necessary. Must be able to communicate effectively with others. Must be able to interpret third-party coverage and institution's charges. Preferably C.P.A.R. certified, but not required.

Exposure to hazards (body fluid exposure level) Level III.

Age of Patient Populations Served: No patient contact.

Job Specific Duties and Performance Standards

Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position's purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.

Major Tasks, Duties and Responsibilities:

• Bills electronic and paper claims using the hospital computer systems.
• Corrects any errors detected on claim forms prior and post claim filing.
• Files adjustment claims based on review of available account detail (late credits, charges, denials, etc.).
• Analyzes, computes, and requests adjustments to accounts as needed.
• Attends seminars and workshops directly relating to third-party billing procedures as requested by management.
• Responds to all telephone inquires to billing in accordance with established procedures.
• Ensures that all potential payments are received prior to billing the patient.
• Keeps coordinators and/or management updated on workload, denials, and appeals for their payor group.
• Reviews denied claims for rebilling and no pay claims to ensure that proper payments are received.
• Performs rebilling and adjustments required by third-party and private insurance company payments in accordance with timely filing requirements.
• Follows up on all unpaid accounts either by phone or mail in accordance with departmental procedure through the use of collector follow up queues and reports.
• Reviews patient receivable trial balances for incorrect balances and makes necessary adjustments as provided by Coordinators or Director.
• Initiates refund requests in accordance within departmental procedures.
• Files secondary claims timely in accordance with payor guidelines and with proper attachments.
• Requests and uses reports to work assigned accounts to ensure recovery on aged accounts in a timely manner.
• Keeps up to date on payor billing requirements, state and federal regulations.
• Understands UB, CPT, and ICD diagnosis codes as the codes relate to billing/claim filing.
• Documents payor correspondence, actions taken and inquiries on accounts in notes for tracking/audit purposes.
• Ability to produce workable ideas and techniques, willingness to attempt new approaches and perform job duties independently.
• Performs duties in an independent manner with minimal direct supervision.
• Can solve day to day problems within scope of practice and make decisions in a timely manner.
• Offers workable ideas, concepts and techniques to improve productivity.
• Willing to attempt new job duties, tasks, etc.
• Maintains regulatory requirements including all state, federal and Joint Commission regulations related to Patient Financial Services and, as appropriate, to the facility.
• Performs any other task as requested by Supervisor or Management in a willing and positive manner.