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Healthcare Billing and Collections Specialist
2 months ago
The Billing Specialist plays a crucial role in managing patient accounts and ensuring accurate billing processes. This position involves a range of intricate clerical and financial tasks related to patient invoicing, including verifying billing details, maintaining records for third-party payers, and addressing various billing issues. The specialist is responsible for following up on claims and patient invoices, collaborating effectively within a team environment.
Key Responsibilities
1. Manages and processes billing claims for patients and insurance providers, ensuring all supporting documentation is accurately maintained.
2. Investigates and addresses inquiries from patients or insurance companies regarding billing matters, providing assistance in person, via phone, or through written communication.
3. Monitors submitted claims, tracks unpaid accounts, and initiates follow-ups using electronic health record systems; re-files claims as needed within standard billing timelines.
4. Accurately posts and reconciles payments to patient accounts, verifying each insurance payment against agreed-upon rates.
5. Identifies and processes claims for secondary and tertiary insurance providers.
6. Reviews accounts receivable and advises supervisors on accounts that are overdue.
7. Analyzes patient records and tracks billing data for multiple visits.
8. Follows up on appeals, denials, and rejected claims with insurance companies.
9. Maintains organized billing and filing systems in compliance with established protocols.
10. Upholds the confidentiality of financial records in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
11. Ensures that all recorded CPT/HCPCS/ICD codes in provider documentation align with the requirements of insurance carriers and comply with federal and state regulations.
12. Stays informed about ICD/CPT/HCPCS coding and any specific coding requirements relevant to federally qualified health centers to ensure optimal practices in revenue management.
13. Performs additional duties as assigned.
14. Promotes and embodies the core values of the organization: Accountability, Excellence, Integrity, Quality, and Teamwork.
Experience Requirements
- At least one year of experience in a medical office environment.
- A minimum of three years of experience in medical billing.
- Experience with multi-specialty group coding and billing.
- High school diploma or equivalent.
- Medical Coding Certificate; RHIT or CPC certification from AAPC or AHIMA; must meet state licensing requirements.
- Proficient in computer skills and maintaining automated recordkeeping systems.
- Familiarity with Electronic Medical Record software, Microsoft Office Suite, and Google Drive.
- Strong written and verbal communication skills.
- Ability to work independently and as part of a team.
- Capable of multitasking, prioritizing, and managing time effectively.
- Attention to detail and accuracy.
- Organized and goal-oriented team player.
- Bilingual in English and Spanish is preferred.
- Knowledgeable about healthcare regulations and insurance payer policies, ensuring compliance with coding standards.
- Understanding of medical terminology, anatomy, and physiology.
Upon receiving a preliminary job offer, a physical examination will be required prior to acceptance.
Light to moderate physical activities include sitting, standing, walking, reaching, bending, hearing, and speaking for up to eight hours daily. Good vision is necessary, with or without corrective lenses. The ability to lift up to twenty pounds is required, primarily for occasional lifting of office supplies and minor equipment.
