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.
• Accepts and implements change in a positive and professional manner.
• Maintains scanned copies of all pertinent financial clearance documentation within the EHR.
• Informs management of all extraordinary situations encountered related to billing/collections.

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.
• Monitors clearinghouse claims processing daily for claims management.
• 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.
• 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.
• Ensures effective internal controls through following all general accountability principles.
• Manages work process to maintain high quality standards on increasing case volume.

Quality

• Ensures 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.
• Collects 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.
• Ensures compliance 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

• Manages work process to maintain high quality standards on increasing case volume.
• Utilizes all available automation tools.
• Introduces new or improved tools when applicable.
• Provides 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.