REPORTS TO:

SUMMARY STATEMENT & PURPOSE

The Billing Specialist, a key position in the Revenue Cycle, manages the submittal of clean claims to third party payers, either electronically or by paper, including accurate and timely claim creation, follow-up and correspondence with providers, and insurance inquiries/correspondence. The incumbent will assist in the clarification and development of process improvements, account statements, preparing and reviewing financial reports, physician billing, and assure payments related to patient services from all sources are recorded and reconciled timely in order to maximize revenues.

• A minimum of one (1) year experience in insurance billing or experience in a healthcare environment required, or a combination of education, training, and/or experience in a healthcare environment.
• Oriented and sensitive to patient needs and aware of the importance of maintaining strictest confidentiality of patients and employees, adhering to all HIPAA guidelines and regulations.

• Knowledge of Medicare, Medicaid, and HMO desired
• Experience with insurance portals and business software programs preferred

EMPLOYEE RATES AND BENEFIT

• One hundred and sixty-eight hours paid time off per year to include 6 major holidays.
• Employees (and their families) are covered by medical, dental, vision, and basic life insurance with FSA/HSA available.
• 401(k) plan with company matching
• Tuition reimbursement

• This position may require flexible hours, to include overtime.

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  Ensure all facility and physician accounts are prepared for proper billing and account billing productivity standards are met.
• Review the daily unbilled report and make corrections when required; ensuring accuracy of clean claim data; including authorizations, admit service, revenue codes, diagnoses, contract rates, and benefit reimbursement method.
• Prepare and submit timely insurance billings to primary, secondary, and tertiary payers.
• Monitor electronic billings to ensure acceptance through clearinghouse or intermediary. Work any rejections and forward any unresolved issues to collectors for assistance.
• Issue adjusted, corrected, and/or rebilled claims to third party payers.
• Ensure all accounts have correct contractual adjustments posted, either automated or manual, and manual adjustments are noted.
• Posts adjustments, transfer of responsibility (secondary insurance billing, patient responsibility, or collections), and refunds, as necessary.
• Respond to correspondence and complete re-bill requests within 72 hours of receipt.
• Work closely with physicians billing agency and reconciling cash.
• Notify collector and document account when payments are denied.
• Denial and insurance follow-up management.
• Analyze accounts to determine account is netted down based on contract rate.
• Act as back-up for the Data Processor on an “as needed” basis, posting the daily deposit and reconciling the FCR.

• Knowledge of all code procedures.
• Knowledge of computers and business software.
• Knowledge of CPT coding and insurance billing.
• Skill in organizing and prioritizing workloads to meet deadlines.
• Skill in telephone etiquette and paging procedures.
• Effective oral and written communication skills.
• Ability to communicate effectively with patients and co-workers.
• Ability to adhere to safety policies and procedures.
• Ability to use good judgment and to maintain confidentiality of information.
• Ability to work as a team player.
• Ability to demonstrate tact, resourcefulness, patience and dedication.
• Ability to accept direction and adhere to policies and procedures.
• Ability to recognize the importance of adapting to the various patient age groups (adolescent, adult and geriatric).
• Ability to work in a fast-paced environment.
• Ability to react calmly and effectively in emergency situations.
• Ability to meet corporate deadlines.