Billing Specialist

3 days ago

Virginia Beach, Virginia, United States Adler Therapy Group Full time

Summary/Purpose:

The Billing Specialist will be responsible for verifying insurance eligibility and coverage, coordination of benefits, and obtaining authorization for services in an outpatient therapy setting. This includes managing patient accounts so that they are paid correctly and within an acceptable timeframe, answering patient billing inquiries, and supporting clerical functions, as needed.

Tasks
(Essential Job Functions denoted with (E)):

  • (E)
    Effectively provides services remotely using technology in accordance with ATG policy (if approved to work on a remote basis)
  • (E)
    Effectively works independently in a self-directed manner
  • (E)
    Responds promptly to communication from the Practice and/or a client
  • (E)
    Contacts insurance companies by phone and/or online portal to (1) obtain insurance eligibility, benefits, and authorization requirements in an accurate and timely manner, and (2) follow-up on authorization requests and denials in a timely manner
  • (E)
    Accurately records benefit and authorization details on verification forms and in TheraOffice
  • (E)
    Answers patient inquiries by phone or in person regarding benefits details, such as deductibles and copayments/coinsurances, and regarding authorization status
  • (E)
    Requests, follows-up, and obtains authorizations prior to and during treatment episode
  • (E)
    Communicates with scheduling department when authorization cannot be obtained or when insurance coverage is no longer active
  • (E)
    Communicates regularly with billing department director, coordinator, and other

Practice employees regarding questions, problems, and issues that arise

  • (E)
    Accurately and timely updates the Practice's referral tracker to reflect insurance status of patients
  • (E)
    Completes timely analysis of next day report each day and ensures all patients scheduled have been verified
  • (E)
    Follows-up with insurance companies on unpaid or rejected claims
  • (E)
    Researches and resolves incorrect payments
  • (E)
    Answers patient inquiries by phone or in person regarding outstanding account balances and insurance guidelines
  • (E)
    Contacts responsible parties to resolve delinquent accounts
  • (E)
    Prepares payment plans and monitors adherence to the agreed upon plans
  • (E)
    Composes routine correspondence
  • (E)
    Coordinates self-pay agreements with patients/families that follow company self-pay guidelines
  • (E)
    Reviews delinquent self-pay accounts for collections
  • (E)
    Identifies and prepares patient and insurance refunds as needed
  • (E)
    Maintains strictest confidentiality and adheres to all HIPAA guidelines/regulations and Practice policies
  • (E)
    Processes necessary insurance paperwork
  • (E)
    Listens to and resolves complaints from patients
  • (E)
    Receives payment and records receipts for services
  • (E)
    Transmits information or documents to customers using computer, email, mail or facsimile machine
  • (E)
    Collects, sorts, distributes, or prepares mail, email messages, or courier deliveries
  • Files and maintains records
  • Performs administrative support tasks, such as proofreading, transcribing handwritten information, or operating calculators or computers to work with pay records, invoices, balance sheets, or other documents
  • Analyzes data to determine answers to questions from customers or members of the public
  • Greets person entering practice, determines nature and purpose of visit, and directs or escorts them to specific destinations (if working in the office)
  • Schedules appointments and maintains and updates appointment calendars
  • Provides information about the Practice to customers and the public, such as location of departments or offices, employees within the organization, or services provided
  • Performs other duties as assigned with accuracy and timeliness
  • Performs other duties as assigned by the Practice

Work Knowledge:

  • (E) Billing –
    Knowledge of CPT and ICD-10 terminology. Knowledge of third party insurance including timely filing requirement
  • (E) Clerical
    – Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology
  • (E) English Language
  • Effectively communicate in English both verbally and in writing
  • (E) Computers and Electronics
    – Proficiency in Microsoft Office Suite and other software systems used by the Practice related to the job tasks
  • Customer and Personal Service
    – Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction

Work Activities (all are (E) Essential):

  • Requires telephone conversations
  • Requires basic knowledge of computers and software programs
  • Requires use of email
  • Requires writing letters and memos
  • Requires face-to-face discussion with individuals or teams
  • Requires contact with others (face-to-face, by telephone, otherwise)
  • Requires competition or awareness of competition pressures
  • Requires work with others in a group or team
  • Requires work with external customers and/or the public
  • Requires dealing professionally with unpleasant, angry, or discourteous people
  • Requires effectively navigating conflict situations

Physical and Mental Demands and the Environmental Factors:

Occasional (1 – 33% of the time)

Frequent (34 – 66% of the time)

Constant (67 – 100% of the time)

C Requires sitting

C Requires standing

C Requires using hands to handle, control, or feel objects, tools, or controls

F Requires repetitive movement

C Requires repeating the same physical activities or mental activities over and over

C Requires working indoors in environmentally controlled conditions

O Job tasks may be performed in close physical proximity to other people

C Requires operating office equipment (i.e. computer/laptop, telephone, tablet)

O Stooping, turning, bending, squatting, and kneeling

C Sitting at a desk, typing, seeing, hearing, listening and the ability to accurately discern colors as necessary to perform job functions

Education and Experience:

Billing experience in a therapy practice setting preferred

(E)
High school diploma or equivalent

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