Biller/Collector Specialist

Insurance Claims and Patient Statement Billing Position

This position is to generate insurance claims and patient statement billing in a timely and efficient manner in accordance with the Facility policies. In addition, Position is responsible for working the accounts receivable to collect outstanding balances from insurance companies and patients to include working all claim denials, appeal of improper payments and resolution of credit balances. Reviews financial obligation with patient and family member. May perform pre-qualification of third party coverage of scheduled procedures. Participates in cross-training for other Business Office positions. Reports To: Business Office Manager Classification: Non Exempt

Qualifications

High School graduate or equivalent Minimum of two years experience in hospital or medical facility business office. Automated billing system experience preferred.

Responsibilities

1. Maintains standards to ensure systematic, consistent and timely filing of the following claims; Medicare/Medicare HMO and Blue Cross Blue Shield claims. 2. Ensures claims pass edits for correctness per payor requirements. 3. Ensures unbilled claims are reviewed for correctness. 4. Meets all standards set forth in Key Performance Indicators adopted by the Facility. 5. Maintains current information on claims adjudication and payment policies on all government intermediaries. 6. Files Secondary claims to appropriate insurers. 7. Assumes other duties and responsibilities as necessary. 8. Maintains current information on claims adjudication and payment policies on all encountered third party payers and government intermediaries. 9. Maintains current information on correct and lawful practices in billing government and private payers for Prospective Payment System. 10. Monitors accounts receivable to identify billing errors, and timely rebilling. 11. Follows-up on past due accounts with patient or payers. 12. Reports status of accounts receivable as requested. 13. Provides management reports to the Business Office Manager per protocol. 14. Assists with preparation and maintenance of Facility records and reports. 15. Answers patient and family member questions regarding financial responsibility and explains insurance requirements and refers questions to healthcare professionals when appropriate. 16. Communicates pertinent information from the physician, support staff, insurance companies and other significant parties to the patient. 17. Reports regularly to the Business Office Manager about the status of current projects or workflow. 18. Discuss financial obligations with patient or family member, explaining the fees and reimbursement process and responds to any patient inquiries. 19. Comply with facility Standards of Behavior and complete all required education assignments within the designated timeline.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must be able to lift and/or carry over 20 pounds on a regular basis and be able to push/pull over 25 pounds on a regular basis. The employee must be able to stand and/or walk at least two hours per day.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.