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Billing and Collections Specialist
2 months ago
SUMMARY: The ideal candidate will possess expertise in processing claims for Medicare, Medicaid, Worker's Compensation, and various Third Party Payers. Proficiency in bookkeeping and computer skills relevant to claims processing is essential, along with strong organizational abilities and the capacity to work autonomously.
Key Responsibilities:- Exhibit a thorough understanding of medical billing practices.
- Demonstrate familiarity with Level I Healthcare Common Procedure Coding Systems (HCPCS), including Current Procedural Terminology (CPT-4) and International Classification of Diseases (ICD) codes.
- Possess knowledge of Medicare, Medicaid, Insurance Managed Care Plans, and Workmen's Compensation.
- Effectively manage Accounts Receivable, collaborating with management on complex claims.
- Stay updated with bulletins from subscribed plans regarding changes in claims submission.
- Prepare daily deposits promptly.
- Provide telephone support as needed.
- Generate statements and collection letters.
- Conduct follow-up calls for collections.
- Welcome patients with professionalism and respect, whether in person or over the phone.
- Gather payer information and maintain accurate records for new patients.
- Ensure all patient visit information is correct in the system and make necessary adjustments.
- Input patient data into the computer system.
- Print admission documentation.
- Contact insurance providers to confirm patient co-payments and deductibles.
- Collect patient co-payments and deductibles in accordance with payment policies.
- Document payments received in the receipt log.
- Maintain the cash drawer, ensuring daily balance.
- Track patients requiring full payment at the time of service.
- Deliver exceptional customer service to patients and the public consistently.
- Obtain necessary referrals from patients with a Primary Care Physician (PCP).
- Schedule patient appointments as required.
- Maintain logs for collections and quality assurance purposes.
- Download Medicare receipts for accounts.
- Post patient payments accurately.
- Submit claims to Medicare, Medicaid, primary, and secondary insurances.
- Enter charges for services provided.
- Re-submit claims and manage the appeals process as needed.
- Investigate and resolve inquiries from insurance carriers or private patients regarding claims.
- Review and amend claim edits and denials to ensure appropriate payment for services rendered.
- Foster and maintain positive working relationships with colleagues, supervisors, and medical providers.
- Address patient inquiries regarding accounts promptly and professionally.
- Uphold strict confidentiality of financial and medical records in compliance with HIPAA regulations and hospital policies.
- Communicate medical information clearly, both in writing and verbally, to healthcare professionals and the public.
- Participate in meetings as required.
- Perform miscellaneous duties as assigned.
- Effective communication skills, both written and verbal, with the ability to follow instructions and interact well with team members, patients, and families.
- Understanding of insurance policies.
- Proficient in accounts receivable accounting systems.
- Knowledgeable in accounting practices.
- Skilled in Microsoft Office applications, particularly Word and Excel.
- Ability to maintain confidentiality and discretion in communications.
- Familiarity with policies regarding the reporting and release of protected health information (PHI).
- High School Diploma or GED.
- Minimum of 1 year experience in bookkeeping, clerical work, and relevant computer training.
- Experience in a physician's office or medical coding is preferred.
- Customer service training or experience is preferred.
- Ability to communicate effectively in English, both verbally and in writing.
- Proficiency in Spanish is preferred.
- Proficient in mathematical and statistical calculations.
The employee should be capable of responding to diverse situations that may not be addressed by existing standards and procedures.
Work Environment:The employee is regularly required to stand, walk, sit, and navigate stairs. They must have the ability to handle, feel, or manipulate objects and tools, as well as reach with hands and arms. The role may require lifting up to 25 pounds from the floor to waist level. Specific vision abilities include close vision and the ability to focus clearly.