Billing and Collections Specialist

2 weeks ago


Grants, New Mexico, United States Cibola General Hospital Full time

Hybrid Work Environment

POSITION OVERVIEW

The Billing and Collections Specialist is responsible for managing billing and collection processes for patients, encompassing various insurance types including Medicare, Medicaid, and commercial insurance. This role involves tracking multiple insurance claims to address any outstanding balances and assisting patients and their families with financial arrangements, including securing financial assistance from external agencies for eligible patients.

KEY RESPONSIBILITIES

  • Conduct monthly audits of accounts receivable and credits that are over 45 days old, ensuring thorough documentation for productivity tracking.
  • Handle an average of 30 accounts daily, totaling approximately 150 accounts weekly.
  • Collaborate effectively with billing personnel to enhance the accuracy of primary and secondary claims submissions.
  • Examine insurance Explanation of Benefits (EOBs) for possible processing discrepancies.
  • Address denials and respond to inquiries within a two-day period.
  • Ensure proper allocation of balances between insurance providers and patients.
  • Assist patients with inquiries via phone or in-person interactions.
  • Respond to audits and regulatory inquiries as required.
  • Investigate credit balances for assigned insurance accounts.
  • Provide education to staff regarding specific payers.
  • Act as the designated representative for particular payers within the organization.
  • Field patient questions concerning billing statements and inquiries.
  • Maintain effective communication with other departments to facilitate timely corrections.
  • Perform additional duties as assigned.

EDUCATIONAL BACKGROUND AND EXPERIENCE

  • High school diploma or GED required.
  • One to three years of experience in data entry, billing, and claims processing within a healthcare environment, or completion of a billing externship. Relevant education may substitute for experience.
  • Experience in a multi-specialty clinic setting is preferred.

PREFERRED CERTIFICATIONS

  • Billing certification from an accredited billing school.
  • Certification in coding and/or billing may be accepted with demonstrated knowledge of healthcare billing processes.

SKILLS AND COMPETENCIES

  • Proficient understanding of computerized practice management systems, ideally Cerner Electronic Health Record System.
  • Ability to learn billing and collection systems utilized in rural health facilities and critical access hospitals.
  • Strong communication skills to interact diplomatically with diverse groups, including staff, providers, and insurance companies.
  • Demonstrated sensitivity to the patient population served.
  • Capability to manage multiple assignments concurrently while adhering to deadlines.
  • Ability to collaborate effectively in a team-oriented environment.
  • Familiarity with HIPAA regulations as they pertain to medical and behavioral health billing.
  • High level of accuracy and attention to detail is essential.
  • Effective oral and written communication skills.
  • Ability to handle sensitive inquiries or complaints with professionalism.
  • Self-sufficient with minimal supervision.
  • Proficient in computer applications and MS Windows software.
  • Knowledge of Federally Qualified Health Care billing and reimbursement is advantageous.
  • Understanding of Medicare and Medicaid guidelines.
  • General knowledge of UB04 and HCFA1500 claim forms, both electronic and paper formats.

ADDITIONAL QUALIFICATIONS

  1. Bilingual skills (English/Spanish) are a plus.
  2. Experience in healthcare settings is highly preferred.

REPORTING STRUCTURE

  1. This position reports to the Patient Financial Services Director.

PHYSICAL DEMANDS

  1. Ability to sit, stand, and walk for extended periods.
  2. Capacity to view a computer screen for prolonged durations.
  3. Ability to perform repetitive hand and wrist motions for extended periods.


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