Billing Specialist

PRIMARY FUNCTION

Generates revenue by managing patient accounts and billing functions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

Performs all patient account and billing functions including diagnostic/procedural coding; data entry of all patient account and billing information, claims submission for third party reimbursement for all financial classes, and A/R collections.

Responsible for the timely and accurate coding and data entry of patient billing information.

Responsible for the timely and accurate preparation and submission of all initial and refilled third party insurance or reimbursement claims.

Responsible for the timely and accurate processing of patient and third-party payments Provide assistance to staff and patients regarding billing issues and problem resolution in a courteous and timely manner.

Ensures all claims are submitted with a goal of zero errors.

Timely follow up on insurance claim denials, exceptions or exclusions, files appeal as necessary for correct payments or denials.

May provide assistance with review, preparation, and follow up on patient budget correspondence.

Prepare and submit electronic patient statements.

Respond to inquiries from insurance companies, patients, and providers.

Balances daily receipts and prepares bank deposit.

Protects patients' rights by maintaining confidentiality of personal and financial information.

Responsible to keep up to date on ICD and CPT coding pertinent to specialty.

Keeps up to date on all insurance changes and insurance internet sites.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Functions and Duties:

Committed to excellence, best practices, compassionate and superior customer service with every patient and co-worker.

Upholds KP Patient Center Medical Home Certification, requirements, and recertification.

On occasion may be responsible for teaching others or allowing students to shadow daily activities.

Accountable for performing applicable research.

Contributes to general housekeeping that demonstrates pride in the Kids Plus practice and space.

Performs other duties as required.

Attend meetings as required.

QUALIFICATIONS

EDUCATION:

Bachelor’s degree or associate degree in healthcare related field, or equivalent experience.

EXPERIENCE:

A minimum of 3 years required of current healthcare billing experience and detailed knowledge of ICD-10, CPT coding and insurance policies.

KNOWLEDGE, SKILLS, AND ABILITIES

Ability to work courteously and respectfully with patients, co-workers, and vendors.

Proven dependability by consistently being at work and on time and during scheduled hours, following instructions, responding to management direction, and soliciting feedback to improve performance.

Ability to establish priorities and coordinate work activities.

Ability to maintain confidentiality.

Excellent interpersonal, communication and customer service skills.

Strong organization, prioritization and multi-tasking skills required.

Ability to establish and maintain effective working relationships with providers, clinical staff, coworkers, and the public.

Computer experience is essential, including, but not limited to practice management software, and spreadsheet applications.

Strong decision-making skills.

Experience in CPT and ICD coding, familiarity with medical terminology.

Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.

TYPICAL WORKING CONDITIONS

Patient facing

May rotate working in the office and remote/telework.

This job must be U.S. based.

Work is performed in an office setting.

Frequent exposures to communicable diseases, toxic substances, medicinal preparations, possible blood borne pathogens and other condition common to a clinical environment.

Utilizes normal speech and hearing necessary for extensive conversation.

Varied activities including sitting (sometimes for extended periods), reaching, bending, lifting up to 40 lbs., pushing/pulling.

Have the hand-eye coordination and manual dexterity needed to operate a computer, photocopier/scanner, telephone, and other office equipment.

OTHER PHYSICAL REQUIREMENTS

Vision

Sense of sound

Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.