Billing & Collections Specialist

The Billing & Collections Rep follows up on rejected claims and overdue insurance and patient balances using EOB forms and reports; builds and maintains relationships with specified payors; manages patient A/R, statement processing and considers accounts for outside collections

Key Responsibilities include the following:

Charge Entry

• Posts missing charges when discovered

Claims Filing

• Reprocesses all paper and electronic claims for assigned carriers when required — verifies completeness of insurance claim information before sending
• Reviews edit reports from clearinghouse daily and resolves issues so claims can be processed
• Follows up on rejected claims the day that the rejected EOB is received

Claims Account Follow-Up

• Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system "notes"
• Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
• Responds to written and telephone inquiries from patients and insurance companies; manages relationships with personnel from assigned carriers
• Meets with Billing Manager regularly to discuss and solve reimbursement and insurance follow up problems
• Calls carriers to appeal payments that do not match contractual agreement; notifies Billing Manager of payors for which this is a consistent problem; works with Billing Manager and physicians to obtain appeal language for denials and/or unacceptable payment
• Processes requests for insurance refunds, and submits to Billing Manager for approval
• Check payors monthly updates on medical policy/guidelines and report to supervisor

Patient Accounts

• Establishes payment plans within approved guidelines—obtains approval from the Billing Manager when necessary
• Resubmits insurance claims on behalf of patients, if necessary
• Recommends to Billing Manager those accounts needing to go to an outside collection agency and sends out collection letters
• Prints and mails itemized statements to those patients who request them, or transmits claims to outside mailing house for processing
• Processes requests for patient refunds, and submits to Billing Manager for approval
• Meets with Billing Manager, as necessary, to discuss and solve collection problems • Assist patients on claims processing if needed

Payment Posting

• Posts adjustments, withholds, as part of this process, and transfers deductibles and coinsurance to patient responsibility; batches them according to protocol
• Alerts Billing Manager when payments do not match contractual amounts; looks for underpayments and silent PPOs
• Submits balanced payment batches to the Billing Manager daily
• May be required to post all mailed-in payments and electronic payments by line item (in absence of Poster)

General

• Ensure all medical information for patient is accurate, updating when necessary
• Check patient eligibility and benefit verification; update account if discrepancies
• Document all actions taken; scan all documents sent out to payors (ex: appeals paperwork)

Shared Duties/Other

• Ensures that all faxes are cleared off the machine (or routed in the system) and distributed throughout the day
• Sorts incoming reports and directs to appropriate person if not addressed properly
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Maintains and respect the confidentiality of patient information in accordance with company policy & procedure, and HIPAA & compliance guidelines
• Attends regular staff meetings and continuing education sessions as requested
• Presents professional image in manner, appearance, motivation and work habits
• Regular attendance is required
• Performs other duties as assigned

Critical Skills & Attributes

• Academic/Technical Qualifications
• HS diploma or GED required

Industry Experience

• Minimum of 18 months experience in a physician group practice billing department
• Familiar with CPT and ICD-10-CM coding for orthopedic, podiatry & pain management surgery procedures
• Good analytical skills and an affinity for detail
• Knowledge of HIPPA & OSHA guidelines
• Working knowledge of medical practice management systems and electronic medical records
• Basic knowledge of computers and medical terminology is mandatory

Communication Skills

• Excellent verbal, written, and interpersonal skills
• Ability to work well with physicians, employees, patients, and others
• A committed and result-driven attitude to work as a high ethical and professional standard.
• Unquestionable commitment to confidentiality, quality customer service and professionalism.