Commercial Billing and Collections Specialist

Job Purpose

Supports the delivery of all Insurance billing services by final/higher level auditing, correcting, and submitting claims. Ensures that billing services are timely, accurate, and allow for appropriate reimbursement.

Key Responsibilities

• Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims, with the objective of receiving appropriate reimbursement based upon services delivered and ensuring that the claim is paid/settled in the timeliest manner possible.
• Works with assigned community services facilities’ administrators and office personnel to manage relevant accounts receivable.
• Edits claim forms, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct diagnosis, and procedure codes are utilized.
• SUBMIT CLAIMS: Submits Insurance claims, including the maintenance of bill holds and the correction of errors, to provide timely, accurate billing services.
• RESEARCH CLAIMS: Researches claim rejections, makes corrections, takes corrective actions and/or refers claims to appropriate staff members for follow through to ensure timely claim resolutions.
• ACCOUNT FOLLOW UP: Conducts account follow up including the investigation of payment delays to appropriately maximize reimbursement based upon services delivered and ensuring claims are paid and settled in the timeliest manner.
• EVALUATE ACCOUNTS: Evaluates accounts, resubmits claims, performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect.
• RESPOND TO INQUIRIES: Responds to inquiries, complaints or issues regarding patient billing and collections, either directly or by referring the problem to an appropriate resource for resolution.
• PLANS AND ORGANIZES: Plans, organizes, and documents work to deliver business results by meeting or exceeding all individual operating metrics and service line agreement objectives.
• CONTINUOUS IMPROVEMENT: Participates in cross-training and job enlargement opportunities for major job responsibilities. Contributes ideas and actions towards the continuous improvement of Revenue Cycle processes.

Qualifications

• In-depth knowledge of various billing documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of patient accounts.
• Knowledge of insurance and governmental programs, regulations and billing processes, commercial third-party payers, and/or managed care contracts and coordination of benefits.
• Familiarity with medical terminology and the medical record coding process.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Familiarity with Insurance Claims management functions in non-acute settings.
• Knowledge of Patient Management information system applications, preferably MatrixCare, as well as spreadsheet, word processing, and other basic Microsoft Office Suite applications.
• Ability to execute strategy and communicate knowledge of business processes and enabling technologies, specifically in an Insurance Claims function.
• Data entry skills (minimum 50-60 accurate keystrokes per minute).
• Strong accuracy, attentiveness to detail and time management skills.
• Ability to conceptualize, plan, and implement stated goals and objectives.
• Ability to work concurrently on a variety of tasks/projects in an environment that demands a high degree of accuracy and productivity in cooperation with individuals having diverse personalities and work styles.
• Strong relationship-building and communication skills (verbal and written) in dealing with other team members and internal/external customers to expedite the patient accounting process.
• Excellent ability to identify, prioritize, resolve and / or escalate complex problems promptly.
• Able to learn new applications/software systems effectively and efficiently.
• Communicate ideas both verbally and in writing to interact with others using on-on-one contact, formal presentations, and group discussions.
• Securely access and use protected health information (all medical record information) to perform the functions outlined as part of this position description.

Minimum Education and Experience

• AA/AS in Accounting or Business (or Equivalent Education / Experience) preferred.
• Demonstrates experience and a proven track record in Insurance Claims in a medical setting of moderate size and complexity, information systems, and patient accounting applications, as typically acquired in 1-3 years of patient accounting / medical billing positions.
• Experience in month end close activities and reconciling cash received to the patient accounting system.

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