Billing Follow-Up Specialist

Job Summary

Reviews billing data of unpaid claims. Responsible for calling insurance companies and/or checking insurance websites to check status of claims. Submit documentation if required and make any corrections needed to get claim processed and paid.

Essential Functions

• Answers patient questions regarding their accounts and insurance coverage.
• Contacts insurance companies to verify medical insurance coverage for patient and obtain information concerning extent of benefits.
• Determine patient's payment responsibility for procedures.
• Research and correct all insurance denials.
• Identify delinquent accounts, aging period, and payment sources.
• Processes delinquent unpaid accounts by contracting patients and third-party payers.
• Perform various collection actions including contacting patients by telephone and/or letter and resubmitting claims to third-party payers.
• Evaluate patient financial status and establish payment plans.
• Follow and report status of delinquent accounts.
• Review accounts for possible assignment to collection agency or other account determination.
• Help patients with Patient Assistance programs.
• Responds to patient/payer inquiries in a timely manner.
• Follows up on unpaid or improperly paid claims as necessary.
• Reviews and monitors select accounts within the accounts receivable.
• Ensure patient confidentiality and follow HIPAA guidelines.
• Promote a professional image by adhering to the established dress code as listed in Employee Handbook.
• Check and resolve assigned tasks in EMR program.
• Assist co-workers as needed.
• Recognize when others are in need of assistance, information or directions and offer to help when able, or find someone who can.
• Maintain emotional control and diplomacy at all times.
• Maintain open and positive lines of communication.
• Consistently report to work on time, begins work promptly, and perform duties for entire scheduled shift.
• Notify Administration of absences and tardiness in a timely manner.
• Read new policies and documents as instructed.
• Adhere to company policies and procedures.
• Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage or damage.

Knowledge Performance Requirements

• Knowledge of medical billing and collection practices.
• Knowledge of basic medical coding.
• Knowledge of third-party payer operating procedures and practices.
• Knowledge of Medicare requirements.

Skills

• Proficient skills in computer programs.
• Skill in trouble-shooting insurance claims and problems.
• Skill in establishing and maintaining effective internal and external working relationships.

Abilities

• Ability to accurately enter data and examine insurance documents.
• Ability to deal courteously with patients, staff and others.
• Ability to communicate effectively and clearly.

Qualifications

• A High School Diploma or GED required.
• A combination of six to twelve months of directly related training and/or billing experience in a health care organization is typically required for carrying out the responsibilities for this job.

Physical Requirements

• Ability to work effectively in a fast-paced environment.
• Physical ability to sit, perform data entry and view computer screen for long periods at a time.
• Occasional exposure to communicable diseases and biohazards.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel

Travel may be required.

Scheduled Working Hours

Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.

Other Duties

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

Equipment

• Operate standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.