Billing Specialist

Job Description

Job Description

Description:

Billing Specialist

E/O/E

Position Summary : 

The Billing Specialist manages all RCM aspects for patient accounts, including benefit verification, obtaining authorizations, coding, claim submission, payment posting, and claim follow-up. This position requires a thorough understanding of the revenue cycle process.

Essential Skills/Responsibilities:

• Obtains benefit verifications, pre-certifications, and prior authorizations.
• Responds to all inquiries, billing denials, other correspondence and phone requests in an efficient, timely, and effective manner. Secures needed medical documentation required or requested by insurances.
• Completes RCM related tasks in Practice Management Software.
• Processes claims, both electronic and hard copy ensuring a timely turnaround. 
• Researches account balances and monitors claims for missing information, accuracy and authorization numbers and ensures appropriate collection activity is initiated. Notifies Revenue Cycle Management Team if any billing issues are found.
• Creates provider appeals, re-determinations, re-considerations, etc. according to payer policies.
• Corrects electronic claim rejections/denials; forwards errors to appropriate person when necessary.
• Answers patient calls and questions.
• Documents any patient out-of-pocket costs based on verification of primary and secondary insurances.
• Reviews transactions for account credits or adjustments as necessary.
• Manages unbilled encounters, rejected claims, and rebill reports daily.
• Maintains current knowledge of Billing and Coding requirements and changes for all insurances.
• Supports and trains as needed for Payment Posting, Coding, and Insurance questions.
• Handles any discrepancies with the lockbox vendors and RCM vendors.
• Processes returned checks.
• Establishes and maintains Collections process, by monitoring A/R reports and other RCM related reports.
• Manages no show reporting for all practices and locations, and fee collection.
• Posts data for death certificates and processes all bankruptcy letters making adjustments as necessary.
• Reports any payments received by the practice for accounts at the collection agency to the agency.
• Posts patient and insurance payments and refunds.
• Posts charges for clinic and surgery center within 24-hours of chart finalization.
• Completes all compliance training requested by company and required by law.
• Adheres to HIPAA compliance plan.
• Communicates internally with all ESG/PASCH/PPMS staff.
• Travels to all clinical locations as needed.
• All other duties as assigned.

Requirements:

Education/Training:

High school diploma or general education degree (GED); OR one year coding/billing experience and/or training; OR equivalent combination of education and experience. General knowledge of third-party payers, collection laws, and procedures preferred. 

Skills: 

• Ability to read, analyze, and interpret practice and payer policies and guidelines/regulations/laws. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. 
• Demonstrated excellence in verbal and written communication.
• Demonstrated knowledge of Third-Party payers and collection law procedures.
• Good interpersonal and customer service skills.
• Critical thinking skills for identifying problems and resolutions in a fast-paced environment.
• Ability to calculate figures and amounts such as discounts, interest, commissions, percentages.
• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical or complex instructions and deal with several abstract and concrete variables.

Attributes:

• Represents practice in a positive and professional manner.
• Punctual.
• Team Player; willingness to help other staff, and resourceful.
• Attention to detail while multi-tasking.
• Diplomacy and confidentiality with patients and staff
• Strong work ethic
• Initiative/Self-Motivation
• Effective communicator

Physical Requirements:

• Ability to sit/stand/walk as the job requires for long periods of time, as well as, climb/balance, lift, push/pull and stoop/crouch as needed.
• Ability to operate office equipment requiring the use of one hand.
• Ability to work in a moderate noise level clinic.