Billing Specialist

Billing Specialist

Duties And Responsibilities:

• Review patient account activity to obtain understanding of remaining outstanding amounts due from the patient or insurance funding sources.
• Contact third party payers on a timely basis to obtain claim processing status and clarification regarding claim payment denials.
• Assertively pursue proper adjudication of claim with third party payer while serving as an advocate to both the organization and patient to receive maximum appropriate payment.
• Process necessary adjustments to the patient’s account to reflect net amounts due after scholarships and contracted discounts.
• Prepare timely and accurate patient statements and refund requests according to department policies and procedures and ensure proper mailing of same.
• Respond to all phone calls from patients and private parties regarding any inquiry related to patient account status, including prior insurance payments or denials.
• Be able to properly communicate to patients all organizational policies regarding scholarship funding.
• Work with appropriate responsible parties to arrange for payment plans or other funding alternatives according to department policy.
• Prepare and coordinate all necessary documents and correspondence related to payment plans.
• Assists with the submission and processing of all accounts sent to external collection agency.
• Communicate with the Supervisor of Patient Billing and Accounting regarding any potential adjustments to account balances.
• Absolutely maintain professionalism when communicating and resolving outstanding balances with patients and third-party funding sources.
• Work with internal departments to provide patients with any requested (and appropriate) information related to their treatment that may assist them with potential cost recovery.
• Support other department members with revenue cycle functions during staffing shortages and absences.
• Aid Department Leadership in achieving goals and objectives established by Senior Leadership for the department.
• Utilize the electronic systems and software so that maximum efficiencies are obtained and appropriately escalate issues related to such systems to the proper personnel.
• Abide by any provisions outlined in Third Party Reimbursement Contracts when performing revenue cycle functions.
• Maintain the integrity of all elements of the revenue cycle database when performing related revenue cycle functions.
• Aid in the training and orientation of new employees as directed by Department Leadership.

Qualifications

• A high school diploma or equivalent required.
• 2 years’ previous experience in an electronic billing environment required.
• Knowledge of health insurance medical billing policies and procedures required.
• Previous experience in electronic claims submission and remittance processes preferred.
• If in recovery, 1 year of continuous sobriety preferred.

Physical Requirements

• Must be able to lift up to 25 pounds.
• Will need to sit, stand and type for extended periods of time.
• Flexibility to work on campus and remotely as requested.

Knowledge, Skills And Abilities

• Proficiency with electronic billing management systems, including claims submission and electronic remittance advice processes.
• Can work successfully in a high-pressure environment and respond to multiple priorities.
• Ability to work as a member of a team and to proactively identify necessary changes to processes and procedures which lead to greater efficiencies.
• Capable of resolving problems independently, coupled with the ability to discern the need for escalation and intervention.
• Detail oriented with strong organizational skills.
• Strong technical knowledge and proficiency with computer software systems, specifically Microsoft products such as Power Point, Excel, and Word and data base management systems.
• Must possess excellent communication and customer service skills and have a pleasant phone manner.