Billing Specialist

Responsible for processing third party payor claims, to include research for accuracy and processing appropriate re-billing of outstanding claims. Responsible for posting third party payor payments. Verifies third party coverage and out of pocket amounts. Sends patient statements and makes payment arrangements for outstanding balances. Trains and mentors billing staff members; serves as back-up for departmental manager.

DUTIES AND RESPONSIBILITIES:

1. Makes necessary corrections to patient accounts and third party payor encounters in order to generate claims. Uses the appropriate claims format for each payor type. Transmits electronic claims on a daily basis; mails paper claims when electronic submission is not possible.


2. Processes re-bills accurately and on a timely basis. Re-bills are to be corrected according to denial codes; encounters and charts are to be reviewed as needed; and appropriate research is to be done to have claims processed correctly. Re-bills must be completed within filing deadlines. Responsible for continuous review and monitoring of accounts receivable aging reports.


3. Records third party payments, disallowances, and adjustments in patient accounts via the patient account software. Identifies denials and recoupments; balances posted amounts to remittance reports, and ensures posting is completed by the pre-determined monthly closing date.


4. Verifies third party benefit coverage to include co-pays, deductibles and co-insurance.


5. Sends patient statements for past due balances and applies unapplied credit balances to outstanding balances. Makes payment plan arrangements with patients for past due balances; monitors delinquent accounts and appointments for habitual non-paying patients.


6. Provides excellent internal/external customer service via telephone, email or face-to-face contact to assist patients with their health care needs. Communicates with clients, support staff and third party payors to address billing questions and concerns regarding charges, payments, adjustments, benefits, and possible refunds.


7. Trains and mentors billing staff members with claims processing, entering of individual plans, insurance verification and other billing office duties. Serves as back-up for departmental manager; able to field questions in the manager's absence.


8. Completes special projects as needed (i.e. assist with the ground work for electronic billing, completion of special reports, and problem resolution projects.


9. Performs other related duties as assigned.

JOB QUALIFICATIONS:

High school diploma or equivalent
Two years' experience in billing and collecting of third party health insurance
Knowledge of ICD-9-CM and CPT codes and medical terminology
Extensive knowledge of computerized billing systems
Experience in the use of personal computers, to include proficiency in Microsoft Word, Excel, Outlook
Bilingual in English and Spanish preferred
Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Limited physical effort required; May have to lift folders, files, papers, audio/video equipment, and other such items weighing up to approximately 25 lbs.

Equal Opportunity Employer
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