Accounts Receivable Specialist
2 weeks ago
Sterling Health Solutions, Inc.
Position Title: Billing Specialist I
Reporting To: Director of Revenue Cycle
Department: Finance
Position Summary
The Billing Specialist I is accountable for comprehensive management of medical, vision, and dental billing processes, as well as accounts receivable oversight. This includes charge entry, payment processing, customer support, and follow-up activities, all conducted in alignment with organizational protocols aimed at enhancing patient satisfaction and financial performance.
Key Responsibilities
- Accurately input all charges into the practice management system, ensuring all charge batches balance in terms of both procedure count and total amounts prior to posting.
- Process all credit and debit adjustments to patient accounts in strict accordance with established guidelines.
- Organize and file all charge, payment, and adjustment batches by date for efficient retrieval.
- Review coding by providers during charge entry to ensure compliance with relevant guidelines and to facilitate timely reimbursements.
- Deliver exceptional customer service to patients and authorized representatives regarding billing inquiries, ensuring responses are provided within one business day.
- Verify patient demographic and insurance information during charge entry to ensure accuracy and timely reimbursement.
- Conduct follow-ups on outstanding insurance claims at 60 days post-service, focusing on maximizing patient satisfaction and practice profitability.
- Manage follow-ups on outstanding patient account balances at 90 days post-service, utilizing aged accounts receivable reports.
- Provide relevant information regarding billing, coding, managed care networks, and insurance reimbursement to physicians and management.
- Address returned claims, correspondence, denials, and account reconciliations promptly to optimize reimbursement processes.
- Submit primary and secondary insurance claims electronically on a daily basis to ensure prompt payments.
- Recommend accounts for external collections when internal efforts are unsuccessful.
- Process refunds to both insurance companies and patients in accordance with company policies.
- Monitor reimbursement rates from managed care networks and insurance carriers to ensure alignment with contractual agreements.
- Demonstrate proficiency in all aspects of the practice management system, including patient registration, charge entry, and insurance processing.
- Maintain organized documentation regarding coding, insurance carriers, and managed care networks for easy reference.
- Ensure a professional and efficient work environment while adhering to all compliance policies.
- Other responsibilities as assigned.
Knowledge, Skills, and Abilities
- Extensive knowledge of managed care networks and insurance processes.
- Strong written and verbal communication skills, along with exceptional customer service abilities.
- In-depth understanding of accounts receivable functions, including relevant coding systems.
- Proficiency in using computers and various software applications.
- Familiarity with medical, vision, and dental terminology.
Qualifications
- High school diploma or equivalent required.
- Positive attitude with problem-solving capabilities and the ability to work collaboratively.
- Self-motivated with the ability to work independently.
Preferred Qualifications
- Associate degree preferred.
- Minimum of three years of accounts receivable experience, ideally in a healthcare setting.
- Experience with dental billing software is advantageous.
- Certification as a Professional Coder (CPC) is preferred.
Special Requirements
This position requires a full range of motion, including manual dexterity and eye-hand coordination. The role may involve extended periods of sitting, standing, and walking, and requires the ability to work under pressure. Frequent exposure to clinical environments is expected.
The information provided above outlines the primary responsibilities and qualifications for this position. It is not intended to be an exhaustive list of all duties and skills required. The organization reserves the right to modify job responsibilities as necessary.
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