Billing Specialist

SUMMARY: Coordinates insurance and billing related activities associated with the care of service provided to the customers of the company.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Enter charges accurately and expeditiously to ensure proper records handling and fast payment responses.
• Initiate private pay collections after insurance cancellation, denial or other issue.
• Obtaining referrals and pre-authorizations as well as eligibility and verification of benefit when required.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Following up on unpaid claims within standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Identifying and billing secondary or tertiary insurances.
• Maintain accuracy of tables as well as inform management with rate changes.
• Check to see if claims remain unpaid and follow up with patients and insurance companies to determine the cause of the delay and to keep the billing cycle on track.
• Look into claims that are denied and research how to modify the claim to ensure it is processed correctly at maximum reimbursement.
• Answer inquiries made by patients, insurance companies, or fellow employees regarding assigned accounts, the billing process or the appeals process. This includes reviewing for accuracy, completeness, and obtaining missing information.
• Maintain complete understanding and knowledge of all reimbursement requirements for assigned payer as well as general knowledge for payers outside of those assigned.
• Communicate policy changes/issues to management so information can be communicated out to other areas of company.
• Liaise between payers/provider representatives when necessary.
• Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the billing team and the organization.
• Serves as troubleshooter for accounts receivable problems and as back-up troubleshooter for complete system.
• Other duties as requested by Management.

Requirements

QUALIFICATIONS

To perform this job successfully, an individual must be professional, proactive and positive with internal and external customers and coworkers. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Education and/or Experience

• High school diploma or general education degree (GED).
• Minimum of six (6) months in a medical related field and/or training; or equivalent combination of education and experience.

Skills & Abilities

• Excellent interpersonal, written and verbal communication skills.
• Attention to detail
• Good data entry skills
• Proficiency with computers, with strong typing skills.
• Good organization skills

Language Skills

Proficient English (verbal, written)

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure using a calculator.

Analytical & Problem Solving Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES, LICENSES, REGISTRATIONS

None

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. All employees are required to work in a safe manner.

WORK ENVIRONMENT

The work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Office environment with moderate level noise.

TRAINING

Orientation and selected courses must be completed in the designated time frame.

ADDITIONAL QUALIFICATIONS

None

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Employee signature below constitutes employee’s understanding of the requirements, essential functions and duties of the position. This document is not to be construed as an employment contract of any kind.