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Billing & Collections Specialist

3 months ago

Linden, United States Union County Orthopaedic Group Full time
Job DescriptionJob DescriptionDescription:

Position Summary

To follow up on rejected claims and overdue insurance and patient balances using EOB forms and reports; build and maintain relationships with specified payors; manage patient A/R, statement processing and consider accounts for outside collections



Requirements:

Key ResponsibilitiesCharge 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.