Billing and Collections Specialist

Summary The Billing and Collections Specialist must be customer service oriented, detailed in performing their job functions in accounts receivables with insurance companies and self-pays, and possess the ability to manage multiple tasks daily. Essential Duties Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller. Correct claim issues and/or rebill claims to third-party payers. Claims must be corrected and rebilled within the timely refiling guidelines. Write appeal letters. Communicate with all departments (front desk staff, nursing, providers) to ensure appropriate collection of co-pays and self-pay balances prior to patient visits. Contact patients after obtaining authorization to discuss collection of out-of-pocket expenses prior to visits. Document appointments, call guarantors, and communicate balances that need to be collected. Handle inquiries and answer questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time. Daily monitor assigned insurance A/R, delinquent self-pay accounts, and all assigned WQs. Meet deadlines for completing all assigned WQs before month’s end. Identify and resolve patient billing questions in office and in incoming calls to the business office. Collect and/or post payments from insurers and patients as assigned daily. Review accounts and recommend actions regarding non-collectible accounts. Notify manager of non-collectible self-pays and insurance balances. Verify patient eligibility through third-party sources. Understand patient benefits from all carriers and determine out-of-network status before visits. Document collected payments, A/R, and call resolutions in the software system. Understand fee schedules and update manager on changes and effective dates timely. Monitor policy and fee schedule changes for all assigned carriers and inform manager. Answer business office calls daily and on a rotating weekly schedule. Explain out-of-pocket expenses to guarantors. Assist enrollment and explain drug rebate programs (Care Path, Entyvio Connect, Pfizer). Assist patients in completing paperwork and follow up on assistance programs when needed. Communicate effectively with professional staff and patients. Monitor the business office phone line, calls, and emails daily. Return voicemails within 24 hours. Respond to all emails and staff messages within 24 hours. Collect business office mail and route to appropriate billers. File manually posted payments. Be cross-trained to cover other job functions as needed. Additional duties as assigned by management. Education, Experience, Knowledge, Skills, and Other Qualifications Associate’s degree, or equivalent, 3–5 years related experience, or Medical Billing Certification. Experience working with Medicaid, CMO’s, and commercial insurance. Working knowledge of medical billing systems, particularly Epic. Knowledge of CPT and ICD‑10 coding systems. Ability to research and problem‑solve A/R disputes. Customer service oriented. Productive, dependable, self-starter. Excellent organizational skills. Proficiency in Microsoft Office Suite. Excellent verbal and written skills. Knowledge of medical billing/collection practices required. Strong keyboard skills. Works well in environments with firm deadlines; results oriented. Perform multiple tasks effectively. Works independently and as part of a team. Strong analytical skills. Capable of making timely, independent decisions. Competencies Ethics - Treats people with respect; keeps commitments; inspires trust of others; works with integrity and ethics; upholds organizational values. Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits feedback to improve service; meets commitments. Interpersonal Skills - Focuses on solving conflict, not blaming; maintains confidentiality; listens without interrupting; keeps emotions under control; remains open to new ideas. Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization’s goals; benefits organization through outside activities; supports affirmative action and respects diversity. Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others’ views; gives and welcomes feedback; builds positive team spirit; puts team success above self; builds morale and group commitments; supports everyone’s efforts. Physical Demands and Work Environment Frequent sitting, grasping, and speaking. Occasional reaching, bending, and stooping. Frequent use of computer, keyboard, copy/fax machine, and phone. Possible exposure to infectious specimens (blood or bodily fluids or airborne pathogens). May be required to wear personal protective equipment (PPE). While performing the duties of this job, the noise level in the work environment is usually quiet to moderate. Fast‑paced environment with occasional high‑pressure or emergent situations. Work hours subject to office needs to ensure coverage during all hours of operation. #J-18808-Ljbffr GI Care for Kids