Billing Specialist
JOB DESCRIPTIONTitle:
Billing SpecialistFLSA Category:
Non-ExemptReports To:
Chief Financial OfficerDate Issued:
October 2016Job
Summary:
Responsible for handling all types of insurance claims, including private, Medicare, and Medicaid.
The incumbent is responsible for both patient and insurance collections, as well as making sure that claims are processed in a timely manner so that the organization gets properly reimbursed for services provided.
This includes working on follow-ups, denials, and refunds.
Essential Functions:
Confirm patient demographics and insurance verificationsCharge entry:
Check all visits for retrievable/appropriate ICD-9/10 and CPT codes, according to insurance guidelinesBatch approved visits and send electronically to the insurance company via clearinghousePrint paper claims for secondary insurancesReview Insurance Electronic Claim Submission and Response Reports at least twice weeklyWork Insurance Denials, follow-ups, EDI file rejections, adjustments and agingProcess Unapplied Credit/Refund requests for both patient and insurancesWork Collections/bad debt for both patients/insurancesProcess customer refunds, process and review account adjustments, resolve client discrepancies and short payments.
Monitoring and maintaining assigned accounts to include but not limited to; customer calls, account adjustments, small balance write off, customer reconciliations and/or processing credit memos.
Accountable for reducing delinquency for assigned accounts.
Must communicate and perform follow up effectively with insurance companies and vendors on patient accounts on a timely basis.
Establish and maintain effective and cooperative working relationships with insurance companies and vendors to ensure timely resolution of patient issues.
Reconcile patient disputes as they pertain to payment of outstanding balances that are due.
Assist patients with billing questions, payments, etc.
as needed via phone or in personCall insurance companies as needed to check on claims and patient eligibilityUnderstand and adhere to HRSA guidelines as it pertains to the Sliding Fee Discount Program.
Enlist the efforts of Chief Financial Officer when necessary to accelerate the collection process.
Notify Chief Financial Officer of any unresolved issues on real-timePost Insurance ChecksNon
Essential Functions:
Assist in resolving audit issues assigned by the Chief Financial Officer.
Performs other duties as assignedCompetencies:
QualityRespectIntegrityTeamworkPassionLoveCommitmentSupervisory ResponsibilityNoneManagerial ResponsibilitiesNoneMinimum QualificationsHigh School diploma, GED, or equivalent certification of competency and completion of vocational training in medical billing trade.
SubstitutionsHigh School diploma, GED, or equivalent certification of competency and two (2) to five (5) years of work experience in medical billing.
Competencies NeededAccountability - Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Analytical Skills - The ability to tackle a problem by using a logical, systematic, sequential approach.
Possess creative thinking, learning, systems thinking and problem solving.
Must be effective at defining and solving problems in order to ensure that the real, underlying challenge is understood and that solutions actually address it.
Healthcare Systems - Knowledge of healthcare and medical terminology.
Interpersonal Skills - Work closely with other team members to effectively support their work so that solutions can be effectively implemented.
Serves as a liaison for various staff and/or management and acts as the Point of Contact.
Results Oriented - The ability to focus on the desired results, setting challenging goals, focusing effort on the goals, and meeting or exceeding them.
Reporting - Drafts, runs, and distributes reports.
Provides overview and communicates report findings.
Work EnvironmentThis job operates in a professional office environment.
This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical and Mental DemandsAbility to remain in a stationary position 50% of the time.
Ability to cope with stress.
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine and computer printer.
The person in this position frequently communicates with patients and/or employees.
Must be able to summarize and exchange accurate information.
Performs a variety of duties, often changing from one task to another.
Performs with frequent interruption or distractions.
Adjust priorities quickly as circumstances dictate.
Ability to interact appropriately with colleagues for different purposes in different context.
Expressing or exchanging information to convey detailed spoken instructions accurately, or quickly.
Ability to judge distances and spatial relationships to see objects where and as they actually are.
Cognitive ability to analyze, count, summarize and synthesize information from multiple sources.
Language SkillsAbility to read and interpret written or verbal documents and instructions.
Ability to speak effectively to patients, employees and/or stakeholders of the organization.
TravelMust be able to drive between Greater Baden Medical Services, Inc.
locations.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
Billing SpecialistFLSA Category:
Non-ExemptReports To:
Chief Financial OfficerDate Issued:
October 2016Job
Summary:
Responsible for handling all types of insurance claims, including private, Medicare, and Medicaid.
The incumbent is responsible for both patient and insurance collections, as well as making sure that claims are processed in a timely manner so that the organization gets properly reimbursed for services provided.
This includes working on follow-ups, denials, and refunds.
Essential Functions:
Confirm patient demographics and insurance verificationsCharge entry:
Check all visits for retrievable/appropriate ICD-9/10 and CPT codes, according to insurance guidelinesBatch approved visits and send electronically to the insurance company via clearinghousePrint paper claims for secondary insurancesReview Insurance Electronic Claim Submission and Response Reports at least twice weeklyWork Insurance Denials, follow-ups, EDI file rejections, adjustments and agingProcess Unapplied Credit/Refund requests for both patient and insurancesWork Collections/bad debt for both patients/insurancesProcess customer refunds, process and review account adjustments, resolve client discrepancies and short payments.
Monitoring and maintaining assigned accounts to include but not limited to; customer calls, account adjustments, small balance write off, customer reconciliations and/or processing credit memos.
Accountable for reducing delinquency for assigned accounts.
Must communicate and perform follow up effectively with insurance companies and vendors on patient accounts on a timely basis.
Establish and maintain effective and cooperative working relationships with insurance companies and vendors to ensure timely resolution of patient issues.
Reconcile patient disputes as they pertain to payment of outstanding balances that are due.
Assist patients with billing questions, payments, etc.
as needed via phone or in personCall insurance companies as needed to check on claims and patient eligibilityUnderstand and adhere to HRSA guidelines as it pertains to the Sliding Fee Discount Program.
Enlist the efforts of Chief Financial Officer when necessary to accelerate the collection process.
Notify Chief Financial Officer of any unresolved issues on real-timePost Insurance ChecksNon
Essential Functions:
Assist in resolving audit issues assigned by the Chief Financial Officer.
Performs other duties as assignedCompetencies:
QualityRespectIntegrityTeamworkPassionLoveCommitmentSupervisory ResponsibilityNoneManagerial ResponsibilitiesNoneMinimum QualificationsHigh School diploma, GED, or equivalent certification of competency and completion of vocational training in medical billing trade.
SubstitutionsHigh School diploma, GED, or equivalent certification of competency and two (2) to five (5) years of work experience in medical billing.
Competencies NeededAccountability - Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Analytical Skills - The ability to tackle a problem by using a logical, systematic, sequential approach.
Possess creative thinking, learning, systems thinking and problem solving.
Must be effective at defining and solving problems in order to ensure that the real, underlying challenge is understood and that solutions actually address it.
Healthcare Systems - Knowledge of healthcare and medical terminology.
Interpersonal Skills - Work closely with other team members to effectively support their work so that solutions can be effectively implemented.
Serves as a liaison for various staff and/or management and acts as the Point of Contact.
Results Oriented - The ability to focus on the desired results, setting challenging goals, focusing effort on the goals, and meeting or exceeding them.
Reporting - Drafts, runs, and distributes reports.
Provides overview and communicates report findings.
Work EnvironmentThis job operates in a professional office environment.
This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical and Mental DemandsAbility to remain in a stationary position 50% of the time.
Ability to cope with stress.
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine and computer printer.
The person in this position frequently communicates with patients and/or employees.
Must be able to summarize and exchange accurate information.
Performs a variety of duties, often changing from one task to another.
Performs with frequent interruption or distractions.
Adjust priorities quickly as circumstances dictate.
Ability to interact appropriately with colleagues for different purposes in different context.
Expressing or exchanging information to convey detailed spoken instructions accurately, or quickly.
Ability to judge distances and spatial relationships to see objects where and as they actually are.
Cognitive ability to analyze, count, summarize and synthesize information from multiple sources.
Language SkillsAbility to read and interpret written or verbal documents and instructions.
Ability to speak effectively to patients, employees and/or stakeholders of the organization.
TravelMust be able to drive between Greater Baden Medical Services, Inc.
locations.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
