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.
• Correcting claim issues, and/or rebilling claims to third party payers. Claims must be corrected and rebilled within the timely refiling guidelines of the insurance company assigned.
• Write appeal letters.
• Communicating with all departments, i.e., front desk staff, nursing and providers to ensure appropriate collection of co-pays and self-pay balances prior to patient visits.
• Contact patients after obtaining auth to discuss collection of out-of-pocket expenses prior to patient visits.
• Documenting the appointment desk, calling guarantors and communicating balances that need to be collected.
• Handles inquiries and answers questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time
• Daily monitoring of assigned insurance A/R’s, statuses on delinquent self-pay accounts, and all assigned WQ’s.
• Meets deadlines of completing all assigned WQ’s prior to the end of the month.
• Identifies and resolves patient billing questions in the office and incoming calls to the business office.
• Daily collection and/or posting payments from insurance companies and patients as assigned daily.
• Reviews accounts and makes recommendations regarding non collectible accounts when working delinquent and collection accounts.
• Notifies manager of non-collectible self pays and insurance balances.
• Verifies patient eligibility through various third-party sources.
• Understands patient benefits from various all insurance carriers and determines out of pocket and in and out of network status prior to visits in the office.
• Documents payments collected, A/R, and phone call resolutions in software system.
• Understands fee schedules and updates manager of fee schedule changes and effective dates timely
• Monitors changes in policy and fee schedules for all insurance carriers assigned and informs manager.
• Answers business office phone calls daily and on a rotating weekly schedule.
• Explain out of pocket expenses to guarantor
• Assist in the enrollment and explain drug rebate programs such as Care Path and Entyvio Connect and Pfizer
• Assist patients in completion of paperwork, explain and follow up patient assistance programs when needed.
• Communicate effectively with professional staff and patients.
• Daily monitoring of personal business office phone line, business office phone calls and emails.
• Ensures voicemails are returned within a 24-hour time period.
• Responds to all emails and staff messages from manager, staff and patients in a 24-hour time period
• Daily collection of business office mail, and routing to appropriate billers.
• Filing of manually posted payments
• Cross trained to fill in for other job functions on an as needed basis.
• Additional duties as assigned by management.
  
  
  

EDUCATION – EXPERIENCE- KSA’s – OTHER QUALIFICATIONS

• Associate’s degree, or equivalent, 3 to 5 years related experience, or Medical Billing Certification.
• Experience working with medical payers including Medicaid, CMO’s and Commercial insurance.
• Working knowledge of medical billing systems, particularly Epic.
• Working knowledge of CPT and ICD-10 coding systems.
• Ability to research and problem solve A/R disputes
• Customer service oriented
• A 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 environment with firm deadlines; results oriented.
• Perform multiple tasks effectively.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making timely, independent decisions
  
  
  

COMPETENCIES

Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values.

Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.

Interpersonal Skills - focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.

Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values; 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; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.

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.