Medical Billing & Collection Specialist

Responsibilities

• Answers telephone and provides information on patient statements/correspondence with the appropriate follow-up
• Affords assistance to walk-in customers with questions regarding billing
• Handles complaints and disputes to the proper personnel
• Works encounter interrupts daily
• Works e-mail daily
• Reviews and monitors in-house encounters
• Works incoming correspondences
• Completes encounters in work queues weekly
• Sets contact terms on encounters, which meet minimum payment requirements
• Follows up on delinquent formal payment plans
• Prepares encounters for audits and documents and charges with results of audit
• Researches self-pay encounters for insurance coverage and forwards information to proper area for encounter update
• Prepares encounters for recommendation of refund
• Verifies employment and checks probate court for property and estate claims
• Reviews discharged patients for correctness of patient and insurance information and necessary forms
• Recommends encounters for suit or placement with an outside collection agency or attorney
• Reviews Mobile County Record for court action involving patient encounters
• SUBMIT encounters for estate filing
• Maintains a thorough and current knowledge of billing requirements and reimbursement methodology for all assigned coverages
• Maintains reports and lists as required by management
• Collections and reconciles encounters for assigned coverage
• Responds timely and accurately to written billing inquiries from patients and/or insurance companies
• Makes necessary demographic and insurance additions, deletions, and changes to the system guarantor/patient information
• Utilizes online systems for follow-up and reconciliation of encounters
• Works audit reports received from insurance companies
• Maintains encounter integrity by ensuring that insurance pro-ration, adjustments and transactions are accurate
• Reconciles encounters from Explanation of Benefits
• Maintains encounter integrity by ensuring that insurance pro-ration, adjustments and transactions are accurate
• Reconciles credit balances
• Checks work items and email daily and takes appropriate action
• Identifies solutions to work related problems and issues
• Requests medical records as needed and follows up on receipt of same
• Communicates and uses appropriate customer relations skills with physicians, patients, families and USA personnel in person and via telephone
• Communicates work-related problems and issues to supervisor or management staff
• Maintains accurate and complete records by documenting all follow-up activities with insurance company or patient clearly and concisely on the patient encounter
• Maintains proper filing of patient and insurance correspondence to include Explanation of Benefits and insurance denials
• Maintains contact file folder on all patients with established contract terms
• Adheres to hospital policies including confidentiality
• Regular and prompt attendance
• Able to work schedule as defined and overtime as required
• Related duties as required

Qualifications

• High school diploma or equivalent and one year of medical billing and/or collections experience in a medical office setting
• Hospital billing and claim follow-up experience relating to commercial, UHC and Medicare Advantage plans is highly preferred