Billing Specialist
3 weeks ago
**Title**:Reimbursement Specialist
**Reports to**: Executive Financial Officer
**Updated on**: 05/08/2024
**Status**: Non-Exempt
**Approved by**:HR
***
Primary responsibilities include ensuring all payments, adjustments and denials received from insurance companies are posted to patient accounts timely and accurately. Ensure rejections and denials are reprocessed in a timely manner to ensure payments from the insurance companies. Communicate with patients and/or insurance companies in a friendly professional manner.
**PRIMARY ACCOUNTABILITIES**
- Achieve Results_
1. Correct and refile all rejected and denied claims efficiently and timely.
2. Upload missing documentation requests timely.
3. Monitor reimbursement from payers to ensure payment agrees with upon fee schedule(s).
- 4. Prepare and deliver all reports as directed.
- Operational Excellence_
5. Ensure and uphold the confidentially requirements of all patient records and manage all daily tasks and activities consistent with HIPAA, state and federal laws and regulations, as well as the clinic's policies and regulations regarding confidentiality and security.
6. Assures that all payments issued are appropriate and documented as ordered and received.
- Relationships_
7. Develop and ensure effective, positive relationships within and among the clinic staff, as well as with patients, vendors, contractors, and related resources.
- Professionalism_
8. Ensure all actions, job performance, personal conduct and communications always represent the organization in a highly professional manner.
9. Uphold and ensure compliance with and attention to all corporate policies and procedures, as well as the mission and values of the organization.
**PRIMARY TASKS & DUTIES**
1. Ensure patient balances are correct.
2. Answer all incoming patient calls and respond to their account questions.
3. Adjust patient accounts according to the Sliding Fee Scale guidelines.
5. Review and initiate patient and insurance refunds. 6. Post and mail patient and insurance refund checks.
7. Compile and upload daily deposits for posting.
8. Process patient and Third-Party Credit Card payments, log deposit on the daily deposit database.
9. Post patient payments in PMS and upload third party credit cards in PMS for posting.
11. Arrange for repayment or establish repayment schedules, based on patient’s financial situation.
12. Assist as needed with denied or delinquent claims.
13. Assist billing department with additional tasks as needed.
**ESSENTIAL FUNCTIONS/KEY COMPETENCIES**
1. Function in a multi-tasking, multiple priorities environment, while maintaining accuracy and attention to detail.
2. Communicate with a diverse employee population.
3. Utilize a wide variety of office technology and tools to collect, enter, process, file patient records and documentation.
- Education_
- High School diploma or equivalent. Must be able to speak read, write and understand English.
- Professional _
- “Skilled” business office experience.
- Must be a self-started and take ownership of all job duties and responsibilities.
- Communication, customer service or working with the general public, preferably in a medical care facility.
- General computer competence including basic Word and potential to be trained on specific software for patient information, billing and communication.
- Knowledge of medical terminology preferred.
- Physical/Environmental _
- Ability to interact with computer screen for up to six hours at a time (visual acuity required).
- Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.
- Capacity to function in a sometimes stressful, multi-tasking environment,
- Blood Borne Pathogen Exposure (Please Check One) _
- __ Category I: Job classification includes ALL employees who have occupational exposure* to blood borne pathogens* (blood or body fluids) while performing their job duties.
- __ Category II: Job classification includes employees who are likely to have SOME occupational exposure to blood borne pathogens because Category I tasks may occasionally be required.
- _X_ Category III: Job Classification includes those employees who perform jobs and tasks where NO CONTACT with blood borne pathogens occurs and Category I and Category II tasks ARE NOT a condition of employment.
**LIMITATIONS/DISCLAIMER**:
1. The above job description is meant to describe the general nature and level of the work being performed; it is not intended to be construed as an exhaustive list of all job responsibilities, duties and skills required for the position.
3. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned. Employees will be required to follow any other job-related duties requested by th
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