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Medical Billing and Collections Specialist
2 months ago
Cibola General Hospital is seeking a highly skilled Patient Financial Services Representative to join our team. As a key member of our revenue cycle team, you will play a critical role in ensuring the accurate and timely processing of patient claims.
Key Responsibilities:- Account Management: Maintain and audit accounts receivable/credits over 45 days old monthly, documenting notes for productivity.
- Claims Processing: Work on 30 accounts per day or an average of 150 per week, ensuring accurate and timely processing of claims.
- Billing and Collections: Communicate effectively with billing staff to improve billing primary and secondary claims.
- Denial Management: Review insurance EOBs for potential processing errors and respond to denials and requests/correspondence within a two-day timeframe.
- Patient Communication: Ensure accurate designation of balances between insurance and patients, and assist patients with inquiries over the phone or in person.
- Regulatory Compliance: Respond to audits and regulatory inquiries, and research credit balances for assigned insurances.
- Payer Education: Educate other staff on assigned payers, and serve as the representative for specific payers for the organization.
- Customer Service: Answer patient questions regarding statements or billing inquiries, and communicate effectively with other departments for timely corrections.
- Education: High school degree or GED;
- Experience: One to three years data entry and billing and claims experience in a healthcare setting or billing externship;
- Background: Experience in a multispecialty clinic setting;
- Certification: Billing Certificate, the result of graduation from a certified billing school, or demonstrated proficient knowledge of healthcare billing processes.
- Technical Skills: General knowledge of computerized practice management systems, preferably Cerner Electronic Health Record System;
- Adaptability: Ability to learn billing and collection system within rural health facilities and critical access hospitals;
- Communication: Ability to communicate with tact and diplomacy with diverse groups of people, including staff, providers, and insurance companies;
- Sensitivity: Ability to display sensitivity to the patient population being served;
- Productivity: Ability to work on a variety of assignments concurrently within established deadlines;
- Teamwork: Ability to work with others in a problem-solving and team environment;
- Regulatory Knowledge: Knowledge of HIPAA as it relates to medical & behavioral health billing;
- Attention to Detail: Position requires a high level of accuracy and attention to detail;
- Communication Skills: Ability to communicate effectively, both orally and in writing;
- Conflict Resolution: Ability to respond effectively to sensitive inquiries or complaints;
- Independence: Ability to work independently with minimal supervision;
- Computer Skills: Proficient with computers and MS Windows software programs;
- Specialized Knowledge: Knowledge of Federally Qualified Health Care billing and reimbursement preferred;
- Medicare and Medicaid: Knowledge of Medicare and Medicaid guidelines;
- Claim Forms: General knowledge of UB04, HCFA1500 Electronic and Paper claim forms.
- Language Skills: Bilingual (English/Spanish) preferred;
- Healthcare Experience: Healthcare experience highly preferred.
- Supervision: Reports to the PFS Director.
- Physical Demands: Ability to sit, stand, and/or walk for extended periods of time;
- Computer Use: Ability to view a computer screen for extended periods of time;
- Repetitive Motions: Ability to perform repetitive hand and wrist motions for extended periods of time.
