Patient Accounts Representative - Clinic Billing Office

Medical Billing Specialist

Job Summary: Responsible for compiling itemized patient bills, verifies patient insurance coverage and computes patient insurance benefits mails patient bills, preps claims for submission to insurance, and follows up on insurance claims. Prepares monthly financial statements. Works closely with the medical staff. Participates in performance improvement and QI activities.

Job Duties & Responsibilities:

• Maintains financial records; deposits, contractual allowances, refunds, returned checks, write-offs, revenue, accounts sent to collection agency, and ensures accuracy in data
• Verifies health insurance information. Determines patient charges. Completes insurance forms and submits them to proper agencies/insurance companies.
• Balances books and prepares monthly financial and statistical reports if required by supervisor.
• Reviews and acts on Financial Assistant packets in a timely manner if required by supervisor.
• Maintains an understanding of insurance pre-certification, referrals, appeals, and timely filing deadlines. Stays informed about changes for health insurance policies.
• Maintains current patient contact information including addresses and phone numbers in the computer system to avoid loss of revenue. Verifies patient insurance information for accuracy.
• Maintains all areas of billing software systems as necessary to ensure proper functioning and correct data for processing of claims.
• Answers the telephone in a polite manner. Communicates information to the appropriate personnel.
• Interacts with patients/families in a professional manner. Provides explanations regarding statements and insurance coverage. Treats patients/families with respect and dignity
• Explains financial responsibilities to patients.
• Works with insurance companies and patients in a professional manner when billing problems occur to achieve resolution.
• Uses resources effectively to ensure timely filing and payment of claims.
• Resolves overpayments.
• Properly documents correspondence and conversations with patients and insurance companies, government agencies, and/or third-party payers.
• Performs other duties as assigned.

Requirements:

Professional Requirements:

• Adheres to the dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Maintains regulatory requirements including all state, federal and CMS regulations.
• Demonstrates the ability to be flexible, organized and function well in stressful situations.
• Reports to work on time and as scheduled; completes work within designated time.
• Wears identification while on duty.
• Uses computerized time system correctly.
• Attends staff meetings and reads all staff communication to ensure adherence to policies.
• Completes training as required by employer and position standards.
• Represents the office/clinic in a positive and professional manner.
• Actively participates in performance improvement and quality improvement CQI activities, attends committee and management meetings, as appropriate.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, vision, core values, ethics and goals of the office/clinic.
• Maintains and ensures patient confidentiality at all times including ensuring confidentiality of patient records per HIPAA guidelines.
• Works at maintaining a good rapport and a cooperative working relationship with physicians, departments and staff.
• Ensures compliance with policies and procedures regarding department Operations, fire, safety, and infection control.

Regulatory Requirements:

• High School graduate or equivalent.
• Courses taken in bookkeeping or accounting preferred.
• Two years experience in billing, insurance, office procedures in a medical setting preferred.