Patient Accounts & Billing Specialist - The Wellness Center

Summary of Position The Patient Accounts & Billing Specialist is responsible for basic billing and A/R follow-up including checking eligibility and benefits, obtaining prior authorizations, reviewing and generating electronic claims, electronic payment posting, following up on unpaid claims and patient balances, and reconciling with daily reports. Accuracy is a priority in this role. Duties and Responsibilities Check eligibility and benefits for physical therapy services. Obtain prior authorization, as necessary. Review claims ready for processing to ensure correct rendering and billing providers are identified, verify insurance information, confirm accurate use of modifiers, CPT/HCPCS and ICD-10 linkage, and resolve any claim errors with the objective of achieving a 95% or higher "clean claims" submission rate. Submit all claims electronically to clearinghouse; fax or print and mail secondary claims only when necessary. Review claim submission reports for acceptance by clearinghouse and payers; correct errors as needed and resubmit. Post insurance payments from ERAs and paper EOBs; post patient payments via credit card, in person, or mail receipts. Investigate denied claims for possible appeals. Use documentation to support any appealed claim denials. Manage any other requests received from payers. Review all outstanding claims monthly on payer websites for payment status. Follow up on pending A/R greater than 30 days old for Medicare and Medicaid, and 45 days old for all other payers. Document all contact with payers including date, phone numbers, person contacted, check # and amount, and any other pertinent details. Answer patient questions about claims or balances; return patient calls within 24–48 hours. Take patient credit card payments over the phone. Assist all providers with CPT, ICD-10 and HCPCS coding questions; forward to Revenue Cycle Director as needed for assistance. Inform management of any payer issues or changes that affect claim payment. Maintain strict confidentiality regarding the practice and patients in accordance with HIPAA guidelines. Follow policies as outlined in the Employee Handbook and Policies and Procedures manuals. Other duties as assigned by management. Qualifications According to Indiana Wesleyan University employment policy all employees must possess a strong Christian commitment and adhere to the standards outlined in the IWU Community Lifestyle Statement. Education High School diploma or GED required. Medical billing or coding certification from the AAPC, AHIMA, PMI or other credentialing body (e.g., CPC-Certified Professional Coder; CPB-Certified Professional Biller) preferred. Experience Two (2) years of medical billing office experience in a health care environment; PT/OT experience a plus, preferred. Required Skills Knowledge of Internet. Knowledge of CPT, ICD-10-CM and HPCPS coding. Knowledge of electronic medical records and billing software. Skilled with computers, dual monitors, and standard office equipment. Experience with electronic claim submission, payment posting, payer websites, NCCI edits, Medicare LCDs, and Medicaid policies. Experience with checking eligibility and benefits. Knowledge of prior authorization processes for therapy services. Well organized and detail-oriented. Excellent organizational, communication and time management skills. Excellent customer service skills. Ability to multi-task successfully and refocus on tasks quickly. Ability to take initiative and problem solve without direction. Ability to establish and maintain effective working relationships with patients, employees, providers and the public. #J-18808-Ljbffr Indiana Wesleyan University Nursing