Billing and Collections Representative

Responsibilities

• Submits healthcare claims accurately and efficiently, including researching and correcting denials and errors, applying discounts and adjustments, and resubmitting claims as needed to ensure timely payment.
• Performs billing and collection activities for medical, behavioral health and dental services.
• Creates claims submissions for assigned payers and/or patient accounts.
• Corrects and resubmits rejected claims for assigned payers and/or patient accounts.
• Researches, corrects and resubmits denied claims for assigned payers and/or patient accounts.
• Follows-up with payers via the most effective channel (payer portals, email, phone) to resolve outstanding claims including filing appeals and reconsideration requests.
• Identifies credit balances for assigned payers and/or patient accounts, researches and verifies accuracy of credit balance and submits refund requests as appropriate.
• Identifies account balances meeting the criteria for bad debt write-off, researches and verifies accuracy of balance and flags balances as appropriate to be written off as bad debt.
• Posts third party payments for assigned payers and/or patient accounts accurately to charges.
• Reviews account balances for patients qualified for the Sliding Fee Discount Program and applies discounts to eligible patient charges.
• Performs work in accordance with departmental timelines for claims creation, submission, resolution of claim rejections and denials and open/unpaid claims.
• Aids in reconciliation of patient and payer payments as requested.
• Communicates with credentialing staff and/or external credentialing vendor as needed to ensure necessary enrollments and/or updates are performed to mitigate claims denials.
• Maintains all documents relevant to daily billing functions in internal data repository, e.g. remittance advices, payer correspondence, fee schedule, billing/coding rules, W9 forms, memos, charge slips, training documents etc.
• Provides customer service to internal and external customers.
• Acknowledges, researches, and resolves patient inquiries related to billing and financial counseling functions.
• Provides written notification to supervisor of all patient complaints regarding billing and collections.
• Responds to staff inquiries regarding patient billing and collections.

Qualifications And Skills

• Possesses specific knowledge and training in billing processes and practices, typically acquired during completion of a certificate program in billing practices with a duration of up to a year.
• Possesses a basic knowledge of medical terminology, procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing and of insurance policies and contracts for multiple insurance vendors.
• Current certification as a Community Health Coding and Billing Specialist (CH-CBS).