Billing Specialist

Opportunity

The Billing Specialist contributes to Mosaic’s Revenue Cycle by performing specific billing functions utilizing EPIC billing software and workflows. The Billing Specialist will post payments, review and research past due accounts, follow-up on unpaid claims as assigned to specified work queues, and make collection calls on unpaid accounts. This position is responsible for researching explanation of benefit (EOB) denials to assist patients with inquires on accounts.

Patient Account Duties

• Aid patients with sliding scale discount procedures, payment policies, and understanding charges and payments to their accounts, either by phone or in person.
• Respond to patient inquiries regarding statements and billing questions.
• Identify and resolve patient billing complaints.
• Post payments to patient accounts from patient receipts and from insurance plans; proof, balance, and file payment entries with the day’s transaction reports.
• Research and follow up on unpaid claims and past due balances with third party payers when identified by patient inquiries—primarily as it pertains to MVA, WC, or other specialized accounts.
• Make collection calls to patients on past due accounts.
• Review accounts for possible assignment and prepare information for the collection agency.

Claim Processing Duties

• Aid with eligibility verification with all payers.
• Assist providers as needed with charge entry questions.
• Follow up on unpaid claims and patient accounts using the computerized billing software as a tool, and perform necessary research and functions towards collection for those claims in the correctly identified work queues.
• Resolve claim and charge review errors.
• Respond to insurance company and patient inquiries regarding statements and billing questions.
• Maintain positive working relationships with all staff in all departments and answer all revenue cycle questions from clinic staff.
• Maintain positive working relationships with the Billing Service.

Compliance

• Comply with all policies, procedures, guidelines, and workflows.
• Perform safe work practices to protect the health and safety of employees and patients per OSHA regulation.
• Protect individually identifiable health information per HIPAA regulation.
• Complete all required compliance training within the established timeline.
• Utilize the incident reporting system as needed.

Skills & Knowledge

• Knowledge of billing/collections, traditional health insurance plans, Medicare, Medicaid, and worker’s compensation.
• Knowledge of CPT and ICD9, ICD10 coding principles.
• Knowledge of third-party operating procedures and practices.
• Ability to understand documentation provided in patient chart related to charge entries and the concept of maximum reimbursement.
• Ability to use computerized patient management billing software.
• Understanding of Insurance Explanation of Benefits (EOB’s).
• Ability to research and take necessary action to collect on unpaid claims and patient accounts.
• Basic math skills to balance EOB’s and batches.
• Skilled in the use of calculators, computers, spreadsheet software, word processing software, and excel.
• Prefer someone familiar with HIPAA.
• Excellent general office skills including use of fax, copier, and phone system.