Billing and Collections Specialist

Summary The Billing and Collections Specialist must be customer service oriented, detailed in performing their job functions in accounts receivables with insurance companies and self-pays, and possess the ability to manage multiple tasks daily. Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller. Correcting claim issues, and/or rebilling claims to third party payers. Claims must be corrected and rebilled within the timely refiling guidelines of the insurance company assigned. Write appeal letters. Communicating with all departments, i.e., front desk staff, nursing and providers to ensure appropriate collection of co-pays and self-pay balances prior to patient visits. Contact patients after obtaining auth to discuss collection of out-of-pocket expenses prior to patient visits. Documenting the appointment desk, calling guarantors and communicating balances that need to be collected. Handles inquiries and answers questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time. Daily monitoring of assigned insurance A/R’s, statuses on delinquent self-pay accounts, and all assigned WQ’s. Meets deadlines of completing all assigned WQ’s prior to the end of the month. Identifies and resolves patient billing questions in the office and incoming calls to the business office. Daily collection and/or posting payments from insurance companies and patients as assigned daily. Reviews accounts and makes recommendations regarding non collectible accounts when working delinquent and collection accounts. Notifies manager of non-collectible self pays and insurance balances. Verifies patient eligibility through various third-party sources. Understands patient benefits from various all insurance carriers and determines out of pocket and in and out of network status prior to visits in the office. Documents payments collected, A/R, and phone call resolutions in software system. Understands fee schedules and updates manager of fee schedule changes and effective dates timely. Monitors changes in policy and fee schedules for all insurance carriers assigned and informs manager. Answers business office phone calls daily and on a rotating weekly schedule. Explain out of pocket expenses to guarantor. Assist in the enrollment and explain drug rebate programs such as Care Path and Entyvio Connect and Pfizer. Assist patients in completion of paperwork, explain and follow up patient assistance programs when needed. Communicate effectively with professional staff and patients. Daily monitoring of personal business office phone line, business office phone calls and emails. Ensures voicemails are returned within a 24-hour time period. Responds to all emails and staff messages from manager, staff and patients in a 24-hour time period. Daily collection of business office mail, and routing to appropriate billers. Filing of manually posted payments. Cross trained to fill in for other job functions on an as needed basis. Additional duties as assigned by management. Essential Duties Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller. Correcting claim issues, and/or rebilling claims to third party payers. Claims must be corrected and rebilled within the timely refiling guidelines of the insurance company assigned. Write appeal letters. Communicating with all departments, i.e., front desk staff, nursing and providers to ensure appropriate collection of co-pays and self-pay balances prior to patient visits. Contact patients after obtaining auth to discuss collection of out-of-pocket expenses prior to patient visits. Documenting the appointment desk, calling guarantors and communicating balances that need to be collected. Handles inquiries and answers questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time. Daily monitoring of assigned insurance A/R’s, statuses on delinquent self-pay accounts, and all assigned WQ’s. Meets deadlines of completing all assigned WQ’s prior to the end of the month. Identifies and resolves patient billing questions in the office and incoming calls to the business office. Daily collection and/or posting payments from insurance companies and patients as assigned daily. Reviews accounts and makes recommendations regarding non collectible accounts when working delinquent and collection accounts. Notifies manager of non-collectible self pays and insurance balances. Verifies patient eligibility through various third-party sources. Understands patient benefits from various all insurance carriers and determines out of pocket and in and out of network status prior to visits in the office. Documents payments collected, A/R, and phone call resolutions in software system. Understands fee schedules and updates manager of fee schedule changes and effective dates timely. Monitors changes in policy and fee schedules for all insurance carriers assigned and informs manager. Answers business office phone calls daily and on a rotating weekly schedule. Explain out of pocket expenses to guarantor. Assist in the enrollment and explain drug rebate programs such as Care Path and Entyvio Connect and Pfizer. Assist patients in completion of paperwork, explain and follow up patient assistance programs when needed. Communicate effectively with professional staff and patients. Daily monitoring of personal business office phone line, business office phone calls and emails. Ensures voicemails are returned within a 24-hour time period. Responds to all emails and staff messages from manager, staff and patients in a 24-hour time period. Daily collection of business office mail, and routing to appropriate billers. Filing of manually posted payments. Cross trained to fill in for other job functions on an as needed basis. Additional duties as assigned by management. EDUCATION – EXPERIENCE- KSA’s – OTHER QUALIFICATIONS Associate’s degree, or equivalent, 3 to 5 years related experience, or Medical Billing Certification. Experience working with medical payers including Medicaid, CMO’s and Commercial insurance. Working knowledge of medical billing systems, particularly Epic. Working knowledge of CPT and ICD-10 coding systems. Ability to research and problem solve A/R disputes Customer service oriented A productive, dependable, self-starter Excellent organizational skills Proficiency in Microsoft Office Suite Excellent verbal and written skills Knowledge of medical billing / collection practices required Strong keyboard skills. Works well in environment with firm deadlines; results oriented. Perform multiple tasks effectively. Able to work both independently and as part of a team. Strong analytical skills required. Capable of making timely, independent decisions. COMPETENCIES Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values. Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments. Interpersonal Skills - focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things. Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values; benefits organization through outside activities; supports affirmative action and respects diversity. Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent sitting, grasping, and speaking Occasional reaching, bending and stooping Frequent use of computer, keyboard, copy/fax machine, and phone Possible exposure to infectious specimens (blood or bodily fluids or airborne pathogens). May be required to wear Personal Protective Equipment (PPE). While performing the duties of this job, the noise level in the work environment is usually quiet to moderate. Fast paced environment with occasional high pressure or emergent situations. Work hours subject to office needs to ensure coverage during all hours of operation. #J-18808-Ljbffr