Billing & Collections Specialist

People

• Assigned tasks to be completed accurately, and within specified timelines.
• Affirms Annual competency education is up to date and completed prior to deadlines.
• Participates in regular departmental staff meetings and facility-wide meetings.
• Always on time for work and attendance is within company policy guidelines.
• Willingness to assist in orientation of new staff and ensuring a high level of employee satisfaction and retention.
• Performance self-evaluations to be completed and returned before scheduled date for annual performance review.
• Demonstrates respect and cooperation in all staff relationships, and a genuine willingness to prevent or resolve inter-personal conflicts.
• Fosters an attitude of teamwork and willingness to assist others and does not refuse performing other job duties as requested within the hospital or hospital outpatient department.
• Set's priorities, responds timely to issues, which require a decision, and ensure desired results are achieved by means of consistent, follow through.
• Willingly accepts other assignments as the need arises.

Behaviors/Abilities

• Projects a professional demeanor and appearance while maintaining the confidentiality of patients, co-workers, and the surgery center and adhering to the HIPAA policy.
• Reports, in good faith, any known or suspected activity that appears to violate laws, rules, regulations or the SP Code of Conduct.
• Fulfills annual Competency continuing education requirements.

Functions

• Ensures accurate, appropriate, and timely billing for facility claims of admission of various admission types, payers, and locations.
• Completes claim audit for correct billing/coding/authorization prior to claim submission.
• Completes required claim data fields and edits to ensure clean claim submission.
• Completes claim batch processing through database and claims clearinghouse.
• Maintains workflow of billing and collections processing and communicates issues to management when required action is needed.
• Provides prompt and professional phone courtesy while answering phone calls.
• Ensures retention of billing/collection documentation is maintained in shared drives/location.
• Enters communication documentation in database regularly.
• Informs management of all extraordinary situations encountered related to billing/collections.
• Maintains scanned copies of all pertinent financial clearance documentation within the EHR.
• Documents translation validation appropriately.

Quality

• Assures that business office systems are in place to maintain compliance with State, Federal, and accreditation standards.
• Ensures accurate and complete billing and collections processing and works to maintain departmental quality goals.
• Collection of expected reimbursement as per payer contract.
• Maintains workflow of billing and collections processing and communicates issues to management when required action is needed.
• Provides prompt and professional phone courtesy while answering phone calls.
• Complies with month-end tasks in patient accounting software as required.

Finance

• Manages collection activities to maximize revenue to assure budgeted EBITDA results are achieved.
• Ensures claims processing accuracy meets department goals to promote timely and accurate billing and reimbursement.
• Account management is performed according to SP benchmarks and guidelines.
• Participates in achieving the monthly collection goals.
• Communicates with patients as necessary to discuss financial responsibility.
• Participates in reducing cost of office supply usage resulting in cost effective operations of areas of responsibility.
• Participates in the fiscal management initiatives for the facility as directed by leadership in accordance with SP benchmarks.
• Ensures effectiveness of internal controls through following all general accountability principles.
• Overtime is justified and approved in advance.

Growth

• Manage work process to maintain high quality standards on increasing case volume.
• Utilize all available automation tools.
• Introduce new or improved tools when applicable.
• Provide excellent customer service to all internal and external customers.
• Accepts change as an opportunity for growth, learning and development.
• Adapts to changing procedures and goals in a cooperative and positive manner.
• Willingness to participate in goal-setting and educational activities for own growth and advancements.

Qualifications

• Demonstrates eligibility for employment in the U.S.
• High School graduate or equivalent.
• Minimum of one year of experience in business office activities within a healthcare environment.
• Ability to relate and work effectively with others.
• Demonstrated verbal and written communications in English for contacting payors, patients, and co-workers.
• Demonstrated computers skills in utilizing work processing, integrated database, and understanding of mathematical calculations and medical terminology.
• Ability to use office machines (copiers, faxes, and scanners), and telephone systems.
• Proficiency using and knowledge of Microsoft Office, computers, patient accounting systems and Microsoft Excel.
• Prior cash handling/collection experience is preferred.
• Ability to type 20 WPM.

Other Duties

• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.
• Duties, responsibilities, and activities may change at any time with or without notice.

Patient Population

• The patient population served by South Texas Spine & Surgical Hospital is a minimum of 12 years and/or of adult stature to geriatric patients requiring or seeking pain and/or surgical intervention.
• In addition, our hospital outpatient department patient population served by South Texas Spine & Surgical Hospital is a minimum of 6 months to geriatric patients.

Physical Requirements

• May be expected to lift to 25 pounds or up to 50 pounds with assistance.
• Work is of light-demand, sitting or walking most of the time while on duty.
• Visual and auditory acuity and manual dexterity essential to performing designated duties required: optimal auditory acuity required; manual dexterity involving the handling of equipment and computers is essential to performing assigned duties.
• Physical conditions are clean, neat, and well-lit.
• May be subjected to stressful situations.
• Climates control and ambient temperature variances may be experienced associated with a normal office environment.
• Hours of duty may be irregular or unexpectedly extended due to the requirements of the Business Office.

OSHA Exposure Classification

Job Category III. Tasks/activities do not entail predictable or unpredictable exposure to blood or other body fluids to which universal precautions apply.