Patient Access/ Billing Specialist

POSITION SUMMARY Reporting to the Manager of Patient Financial Services, the Patient Financial Services Specialist to ensure all patients have adequate insurance coverage for our diagnostic service and billed CPT code along with properly recording and storing documents on the patient EMR. ROLES AND RESPONSIBILITIES:

1. Performs insurance eligibility and benefits and precisely documenting coverage cost share (Deductible, Out of Pocket, Coinsurance, Copays) in CRM associated fields.

2. Manages data entry in the Microsoft Dynamics CRM software and may need to contact the patient to properly explain quoted insurance benefit and patient share of cost.

3. Manages daily intake of new prescriptions along with existing patient insurance updates by contacting the insurance company and asking appropriate questions regarding a patient’s insurance benefits.

4. Review and update patient accounts insurance information and ensuring third party payor information is complete and accurate.

5. Files documents received via fax or mail appropriately to attach to a patient EMR in our Microsoft Dynamic CRM while entering and updating patient, insurance, contract, revenue and/or reimbursement data into designated systems.

6. Prepares and submits hardcopy appeal packages, including collecting of all necessary materials for proper appeal creation/modification; making payor specific data changes as required for accurate and timely filing.

7. Contacts insurance carriers as needed to inform the insurance company of an action plan if there is a delay in resolving account for adjudication.

8. Identify review and resolve denied claims as assigned my management. Monitor status of patient accounts and accounts receivable information.

9. Files payor contracts to locate contractual information effectively and efficiently for patient support and claims issues.

10. Files and monitors financial assistance plans, working with management, as necessary.

11. Performs all necessary claim review and research to prevent claim delay as required for accurate and timely billing.

12. Reviews claims having incorrect or missing patient data, facilitates in the correction/addition of missing account data for the purpose of submitting an accurate and timely claim; subsequently initiates and follows through on remedial actions with supervisor to develop solutions that prevent future occurrences when errors are identified as being chronic.

13. Reviews and corrects all necessary items reflected in electronic billing/rejection reports or online claim status query results, delaying a third party payor’s processing of claim(s); Subsequently initiates and follows through on remedial actions with supervisor to develop solutions that prevent future occurrences when errors are identified as being chronic.

14. Receives and responds timely to internal/external phone calls, correspondence, and inquiries related to patient accounts.

15. Supports all aspects of obtaining pre-authorization including communicating and processing information to patients within acceptable time frames.

16. Contact insurance companies via telephone and insurance-based websites.

17. Refer uninsured or underinsured patients to support programs for financial assistance as appropriate.

18. Acts as liaison between insurance company, patients, and Notal Vision.

19. Meets or exceeds established productivity, quality assurance and performance standards.

20. Fosters teamwork by communicating effectively and working cooperatively with others. Has respect for and understanding of other disciplines.

21. Identifies problem accounts with payors; investigates and corrects errors and follows-up on missing account information.

22. Independently maintains uninsured work queue for assigned accounts.

23. Makes adjustment to either patient or practice accounts based on internal reports and/or documentation.

24. Reads, understands and catalogs as needed different Explanations of Benefits in support of patient conversations.

25. Keeps supervisor informed of areas of concern and problems identified.

26. Accepts assignments from management and maintain open communication with their manager to resolve quality and production issues.

27. Maintains strict confidentiality regarding confidential conversations, documents, and files.

28. Participates in educational activities and attends monthly staff meetings.

29. Adheres to all HIPAA guidelines/regulations.

30. Assumes other duties and responsibilities that are related and appropriate to the position and area.

*ORGANIZATIONAL RELATIONSHIPS*

* Reports into Manager, Patient Financial Services.
* Works closely with NVDC departments, management and CRM operations.

*EXPERIENCE AND EDUCATION REQUIREMENTS:*

· High School diploma or GED required/associates degree preferred.

· Two (2)+ years of experience in customer service, medical billing, benefit verification, healthcare or medical office environment.

· Understanding of payer EOBs/Remits.

· Strong computer skills including Microsoft Word, Excel, and fast and accurate typing skills.

· Experience with ICD-10 and HCPCS preferred.

*TECHNICAL / FUNCTIONAL SKILL AND KNOWLEDGE REQUIREMENTS:*

* Excellent customer service skills.

* Must demonstrate ability to work independently with minimum supervision in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs.
* High School Diploma/ GED or equivalent required.
* Minimum 2 years of experience in a busy medical office setting in a front desk, patient accounts, or billing capacity.
* Strong Computer skills required.
* Prior experience and familiarity with insurance plans and terminology.
* Strong communication skills.
* Must be self-motivated, flexible, and dependable.
* Must have strong organizational and time management skills.
* Bilingual a plus.
* Excellent oral, written and telephone communication.
* Ability to prioritize and manage multiple tasks with efficiency in dealing with multiple facilities.
* Ability to handle a large volume of project receiving and researching claims.
* Excellent computer skills, including Excel, Microsoft Word, etc.

*PHYSICAL DEMANDS:*

The physical demands described below 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 otherwise qualified individuals with disabilities to perform the essential functions.

While performing the essential functions of this position, the employee is required to sit for a large part of the work day; continuously using a computer to document or to access information, as well as speaking with internal and/or external customers on the telephone; consistently use repetitive motions of the neck, shoulders, arms, elbows, hands, wrists and fingers while using a personal computer, electronic mouse, telephone headset, fax machines, computer keyboard, and other automated equipment; use hands and fingers to finger, handle, reach for, or feel papers and materials throughout the work day; commit to memory and repeat upon demand detailed information regarding product(s) and services; read from a computer monitor throughout the work day; close vision, the ability to focus, and color vision are required; disseminate to and solicit from customers and other staff detailed information; concentrate intensely for long periods of time.

Work Remotely
* No

Job Type: Full-time

Pay: From $18.00 per hour

Benefits:
* 401(k)
* Dental insurance
* Disability insurance
* Employee assistance program
* Flexible spending account
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday

Education:
* High school or equivalent (Required)

Experience:
* billing customer service: 2 years (Required)
* Benefits and eligibility: 2 years (Required)

Language:
* Spanish (Preferred)

Work Location: In person