Billing & Collections Specialist

Billing & Collections Specialist

The Business Office employee, under the supervision of the Business Office Director and Business Office Supervisor, is responsible for the financial success of the facility as it relates to revenue cycle management. The employee should have a full understanding of each of the processes to maximize reimbursement: collections of all payer types, billing and revenue coding, insurance benefit interpretation, authorization, admission sources, payer specific requirements, contract reimbursement, claim editing, clearinghouse processing, adjudication, and appeals/denial management. It is understood that business office clerks will change tasks from time to time to meet the needs of the business.

Projects a professional demeanor and appearance while maintaining the confidentiality of patients, co-workers, and the surgery center and adhering to the HIPAA policy. Reports, in good faith, any known or suspected activity that appears to violate laws, rules, regulations or the SP Code of Conduct. Fulfills annual Competency continuing education requirements.

Personal attributes include the ability to be self-directed; demonstrates accountability, professionalism, and receptiveness to change; seeks guidance, direction, and assistance when needed. Works under stress and in situations that demand patience, stamina, endurance, and tact while providing impeccable service. Fosters an attitude of teamwork and willingness to assist others and does not refuse performing other job duties as requested within the hospital or hospital outpatient department. Sets priorities, responds timely to issues, which require a decision, and ensure desired results are achieved by means of consistent, follow through. Willingly accepts other assignments as the need arises.

Duties and Responsibilities

People

1. Assigned tasks to be completed accurately, and within specified timelines.
2. Assures Annual competency education is up to date and completed prior to deadlines.
3. Participates in regular departmental staff meetings and facility-wide meetings.
4. Always on time for work and attendance is within company policy guidelines
5. Willingness to assist in orientation of new staff and ensuring a high level of employee satisfaction and retention.
6. Performance self-evaluations to be completed and returned before scheduled date for annual performance review.
7. Performs and conducts self in a professional and appropriate manner in all situations
8. Demonstrates respect and cooperation in all staff relationships, and a genuine willingness to prevent or resolve inter-personal conflicts.
9. Demonstrates the ability to participate in and/or implement team decisions.
10. Accepts and implements change in a positive and professional manner.

Functions

1. Ensures accurate, appropriate, and timely billing for facility claims of admission of various admission types, payers, and locations.
2. Completes claim audit for correct billing/coding/authorization prior to claim submission
3. Completes required claim data fields and edits to ensure clean claim submission
4. Complete claim batch processing through database and claims clearinghouse
5. Review database edits and claim holds for resolution
6. Monitors clearinghouse claims processing daily for claims management
7. Monitors payer websites for claims status and billing updates
8. Interprets payer contracts to ensure payments received is in line with expected reimbursement
9. Capable of adjudication and analysis of claims processing based on payer explanation of benefits
10. Performs daily financial review of accounts receivable for reimbursement
11. Addresses payer denials timely and submits required appeals
12. Processes payer correspondence and appropriately addresses requests
13. Communicates with other departments/provider offices as it pertains to resolution of reimbursement for collection
14. Completes required billing/collection reports as assigned by management
15. Assist with timely month end billing/collection processes
16. Addresses payer issues with patients when related to billing & charge issues, coordination of benefits, third-party liability, injury, PIP, denials, non-coverage, etc.
17. Makes required corrections to patient demographic for claims processing
18. Ensures retention of billing/collection documentation is maintained in shared drives/location
19. Enters communication documentation in database regularly
20. Informs management of all extraordinary situations encountered related to billing/collections.
21. Maintains scanned copies of all pertinent financial clearance documentation within the EHR.
22. Consistently uses facility approved translation system for proper patient communication when a translator is required. Documenting translation validation appropriately.
23. Performs other duties as assigned
24. Demonstrates competence to perform assigned and general customer assistance responsibilities in a manner that meets the age-specific and developmental needs of customers encountered.

Service

1. Develops and maintains a culture of service in department, connecting organizational values to actions.
2. Utilizes every opportunity to improve the patient's understanding of financial responsibility.
3. Assures the department provides a high level of Patient Satisfaction through interactions, discussions, and recognition of team members.
4. Assures a high level of Physician Satisfaction with responsible departments, models interactions with physicians to managers and staff, and participates in development and implementation of action plan as needed for improvement.
5. Effectively accesses SP Service area resources and implements recommendations.

Quality

1. Assures that business office systems are in place to maintain compliance with State, Federal, and accreditation standards.
2. Complies with departmental policies and procedures to meet regulatory and community standards.
3. Ensures accurate and complete billing and collections processing and works to maintain departmental quality goals.
4. Collection of expected reimbursement as per payer contract
5. Maintains workflow of billing and collections processing and communicates issues to management when required action is needed.
6. Provides prompt and professional phone courtesy while answering phone calls
7. Complies with month-end tasks in patient accounting software as required.

Finance

1. Manages collection activities to maximize revenue to assure budgeted EBITDA results are achieved.
2. Ensures claims processing accuracy meets department goals to promote timely and accurate billing and reimbursement
3. Account management is performed according to SP benchmarks and guidelines,
4. Actively participates in achieving the monthly collection goals. Communicates with patients as necessary to discuss financial responsibility
5. Participates in reducing cost of office supply usage resulting in cost effective operations of areas of responsibility.
6. Participates in the fiscal management initiatives for the facility as directed by leadership in accordance with SP benchmarks.
7. Ensures effectiveness of internal controls through following all general accountability principles.
8. Overtime is justified and approved in advance

Growth

1. Manage work process to maintain high quality standards on increasing case volume.
2. Utilize all available automation tools. Introduce new or improved tools when applicable.
3. Provide excellent customer service to all internal and external customers
4. Accepts change as an opportunity for growth, learning and development. Adapts to changing procedures and goals in a cooperative and positive manner.
5. Willingness to participate in goal-setting and educational activities for own growth and advancements

Qualifications:

• Demonstrates eligibility for employment in the U.S.
• High School graduate or equivalent
• Minimum of one year of experience in business office activities within a healthcare environment
• Ability to relate and work effectively with others
• Demonstrated verbal and written communications in English for contacting payors, patients, and co-workers
• Demonstrated computers skills in utilizing work processing, integrated database, and understanding of mathematical calculations and medical terminology
• Ability to use office machines (copiers, faxes, and scanners), and telephone systems
• Proficiency using and knowledge of Microsoft Office, computers, patient accounting systems and Microsoft Excel
• Prior cash handling/collection experience is preferred.
• Ability to type 20 WPM

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