Billing Specialist - Follow-Up (No-Fault & Workers Comp)

Job Description

Job Description

Dent Neurologic Institute is committed to excellence in all we do.  Our culture is built on 4 key pillars: respect, quality, productivity, and well-being.  By remaining dedicated to these values and the overall mission, we are dedicated to making a difference for both patients and colleagues.   When you join the Dent team, you can take advantage of a variety of benefits:

• Work-Life Balance (no overnight shifts)
• Medical, Dental & Vision Plans
• Life Insurance
• 401(k) Retirement Plan
• Critical Illness, Accident, & Legal Plans
• Wellness Program
• Learning & Development Opportunities
• Paid Time Off
• Paid Holidays 
• Free Onsite Parking at All Locations

Working Schedule:   Full-time,  Monday - Friday, 8:30 am to 5:00 pm

Location: Amherst

Position Summary:   Under direct supervision, is responsible for initiating and coordinating a specific function of Follow-up to review and collect on all submitted medical claims.  

Responsibilities:

• Follow up and Denial process
• Research and following up on outstanding receivables via telephone, provider inquiry form and written correspondence. Document every claim with current status of appeal, as well as call reference numbers and/or insurance representative information.
• Very dependent on technology to accomplish tasks efficiently and effectively, must have working knowledge of computer applications such as Word, Excel, and internet browsers to access various insurance carrier websites for updates and insurance procedures/treatment policies. Staff is to utilize all available resources and correct and appeal claims including documentation of the service, medical literature, pre-certification, authorizations, procedure and diagnosis coding manuals, and reference materials.
• Understanding of payer appeal process when claims appeal efforts do not succeed, must know when and how to move to a formal appeal process.  The formal appeals process varies by each payer. Must understand the reason for the denial and the nature of the appeal, constructing a successful appeal letter, and knowing what to include within each appeal.
• Work assigned Insurance Denial Bucket
• Work assigned Follow-up claims
• Working Medicaid claims by putting them through epaces
• Responsible for working 45, 90,120+ day aging claims
• Negative Balance Claims and Refunds
• Meeting claim filing deadlines
• Printing HCFA claims
• EBO report generated every Monday for patients with Balances. 
• Process Medical Expense Reports.
• Sort mail appropriately and working Insurance correspondence
• Strict adherence to Dent policies, Refund policies and other Accounts receivable policies is required.  
• Performs other duties assigned by Billing Manager, Team Lead, Sr. Revenue Cycle Manager or CFO.
• Answer all phone calls in an effort to assist patients with billing questions
• Ability to accept responsibility for appropriate conduct within the office setting and with other department associates by interacting calmly, respectfully and in a friendly manner with other representatives of services at Dent
• Maintains strict confidentiality of patient information.
• Completes duties in a time efficient manner as set forth by the Team Leader. Reports errors or problems so that appropriate action may be taken for patient care.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Skills & Experience Necessary:

• Must have understanding of the different insurance plans, contracts and policies.
• Must know how to interpret EOB’s, understand copay, co-insurance, deductibles and retractions.
• Knowledge of other billing process such as claims management, charge entry, payment posting and patient financial clearance
• Knowledge of insurance verification process, referral and authorizations requirements.
• Knowledge of electronic claim submission
• Understanding of patient check-in/check-out process along with a working knowledge of CPT, ICD-9, ICD-10, HCPCs and Modifiers.
• Previous working experience in an outpatient medical practice
• Medical Terminology
• Strong sense of urgency to work within deadlines
• Ability to prioritize multiple tasks simultaneously in an occasionally stressful environment.
• Strong general office skills, including typing skills  
• Strong customer service, planning, problem solving and organizational skills  
• Working knowledge of Microsoft windows programs including Excel and Word  
• Working knowledge of general office equipment including multi-line phone, computer, copier, calculator, and fax machines 
• Effective communication and interpersonal skills 

Required Education:

• High school diploma with a minimum of 2 years of Medical Billing experience

Preferred Education:

• Associates Degree in Medical Billing and Reimbursement with a minimum of 1 years of Medical Billing experience

Working Conditions:

• Normal working environment, typical of most office settings 
• Minimal physical effort, requires some lifting of files, usually not in excess of 15 pounds. 
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions 

  Compensation:

• Most candidates will start within the first quartile of the pay range
• Rates are commensurate with experience

EEO Statement 

Dent Neurologic Institute offers an inclusive work environment built on kindness and respect for all.  Dent provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws as the basis for an employment decision.  All qualified individuals are encouraged to apply and will receive consideration.