Commercial Billing & Collections Specialist

POSITION PURPOSE:

The Commercial Billing and Collection Specialist is responsible for the timely generation of claims and collections of outstanding accounts receivable dollars from the existing client base and all other aspects of collections, resolving insurance billing problems and reducing accounts receivable delinquency as they relate to recent rejections or failure to pay within thirty (30) through sixty (60) calendar days.

POSITION REQUIREMENTS/QUALIFICATIONS

EDUCATION:
Bachelor's degree (B.A./B.S.) from four-year college or university; or two to four years related experience and/or training; or equivalent combination of education and experience. Minimum of high school diploma or equivalent required.


EXPERIENCE:
Minimum of 2 years' experience in medical billing and coding

KNOWLEDGE AND TRAINING REQUIRED AT TIME OF HIRE:

• Knowledge of the Principles and Practices of the discipline.
• Knowledge of Joint Commission Standards.
• Demonstrates Proficiency in Communication & Written skills.
• Knowledge of State & Federal Statutes Regarding Client Confidentiality laws.
• Knowledge of Drug-Free Workplace Policies.
• Knowledge of Workplace Violence
• Strong communication skills, problem solving and working knowledge of insurance payment methodologies.
• Attention to detail with an eye for accuracy.
• Excellent written and verbal communication skills
• Knowledge in reading, analyzing, and interpreting common scientific and technical journals, financial reports, and legal documents.
• Effective in presenting information to top management, public groups, and/or boards of directors.
• Knowledge in writing professional emails, formal letters, speeches, and articles for publication that conform to prescribed style and format.
• Knowledge in calculating figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. A
• Knowledge in applying concepts of basic algebra and geometry.
• Creative, self-disciplined and capable of identifying and completing critical tasks independently and with a sense of urgency.
• Ability to prioritize and manage multiple responsibilities.
• Proficient in using Microsoft Office Products

SPECIFIC AREAS OF RESPONSIBILITY TO POSITION

1. Submits insurance claims via electronic clearinghouse and paper claims via mail.
2. Performs audits of assigned accounts before submitting claims to ensure accuracy and validity.
3. Provides continual follow-up within the billing software to ensure claims are received by insurance companies appropriately.
4. Reviews claim holds and facilitates clean claim processing.
5. Works within the department and with the other departments to ensure precise submission of claims.
6. Ensures client demographics are correctly entered in the billing software.
7. Participates in companywide and departmental meetings.
8. Commits to providing excellent customer service while maintaining the highest degree of professionalism while working in a team environment to meet goals.
9. Adheres to all company policies and procedures.
10. Understands and complies with all HIPAA rules and regulations.
11. Reviews all open claims for collection efforts needed.
12. Reviews and effectively troubleshoot all known denials and rejections through correspondence or telecommunication.
13. Makes outbound collection calls to commercial payers in a professional manner.
14. Resolves insurance related problems and reduces accounts receivable delinquency, applying professional customer service skills in a timely manner.
15. Makes demands on insurance due payments in accordance with payment due dates, state and federal regulation.
16. Identifies issues attributing to account delinquency and non-payment and discuss them with direct manager.
17. Reviews and monitors assigned accounts and all applicable collection reports and other insurance due related duties as assigned.
18. Provides timely follow-up on payment guarantees and claims rebilled for payment.
19. Mails correspondence to customers/insurers to encourage payment of delinquent accounts and make certain scans of all outgoing demands are made.
20. Faxes documents, medical records, authorizations, or other requested information (within reason) to insurers and perform follow up as required to maintain company standards.
21. Performs other duties assigned.