Billing Specialist II

Essential Job Duties

• Ensure all claims are submitted for prompt payment.
• Review, batch, and transmit/print claims/statements as assigned in a timely fashion.
• Work any rejected files/claims/statements at time of submission to ensure all claims sent were received at Clearinghouse and sent to insurances/patients.
• Maintain AR. Monitor the assigned AR to ensure maintenance of a days in AR ratio of less than 90 while maintaining a standard gross collection ratio.
• Work collaboratively and proactively with insurance companies and patients to resolve issues that will lead to payment.
• Communicate to Manager any backlogged AR.
• Ensure credit balances are worked within 60 days.
• Process Payments and Rejections. Process and post Credit Card, EOB and ERA payment files timely and accurately to ensure we balance deposits to postings for every batch.
• Coordinate with other billing staff to ensure all payments/deductibles/copays are posted monthly.
• Input CAS codes (including Rejection codes), date and COB information at time of posting and approve secondary claim to ensure claims are transmitted to Secondary Insurances the day after posting.
• Responsible for resolving rejected claim issues to ensure payment of claim.
• Ensure all rejected claims are worked in timely fashion.
• Research rejections which include calling insurances to help understand what needs to be corrected and follow through on resubmission of claim based of insurance requirements.
• Communicate with Manager and staff on claim issues.
• Assists department maintaining patient accounts and providing customer service.
• Answer telephone calls from patients and insurance carriers, providing complete and accurate information to resolve any claim related issue in effort to collect payment on services rendered.
• Initiate payment plans and review patient account in efforts to obtain payment and clean up all visits on the patient account.
• Verify all visits that are outstanding or have credit balance are worked correctly and resolved.
• Advise patients of balances that are past due, attempt to obtain payment/set up budget plans and coordinate Collection Agency balances as applicable.
• Handle any incoming mail as instructed by Manager.
• Act as assistant to other specified positions as assigned. Prepare applications and any other required paperwork in efforts to complete processing of requested documents in a timely manner.

Marginal Job Duties

• Acts as backup to other Specialists as directed by Manager.
• Level I: Performs duties as assigned.
• Level II: Senior Level Billing Specialist will need to have the advanced skill set and knowledge to review AR and find trends in rejected claims and research why it was rejected and how it can be fixed. Ability to work well with others and train staff while taking the initiative to resolve issues and know who to call and how to follow through. Knowledge of all aspects of the department is required and expectation that they can and will assist Management in following the Billing Department policies. The move to the Senior level will be given to those that are at a higher level of knowledge in the department and are able to work independently to obtain results required by Director.
• Level III: Senior Level Specialists with Certifications (CPC, RHIT, RCC or a degree) and/or Assistant Duties are responsible for providing support/assistance to that specified Department. This requires specific knowledge and additional work at this level and the ability to coordinate with staff and work with no supervision understanding the details needed to complete the task accurately and in a timely manner.