Medical Billing Office Specialist

Key Responsibilities

• Front Desk Reception: Answer and manage a multi-line switchboard quickly and professionally, adhering to PGL Customer Service and Telephone Call Handling protocols. Direct calls to the proper destination without delay, or take thorough and accurate messages and relay to the appropriate PGL recipient. Provide excellent customer service to PGL guests and clients; respond clearly and effectively to questions and concerns both in person and over the phone. Issue appropriate visitor badges/access and maintain visitor logs. Receive, log, and route deliveries and packages entering the front door. Complete and store daily logs of all front desk activities on the shared drive for management review.
• Patient Demographics, Eligibility & Charge Entry: Work the Demographic Queue to verify and update patient personal and payer-related information prior to claim creation and submission, ensuring accurate billing data and minimizing insurance rejections and denials. Perform interactive eligibility checks during Demographic queue processing by utilizing state of the art software to inquire through the billing clearinghouse and reviewing eligibility responses. Perform charge capture and balance daily batches; complete required production reports. Report new facilities, referring physicians, or insurers requiring interface table updates; flag facilities or physician offices that routinely fail to provide necessary information.
• Remittance Processing & Payment Posting: Process and post both electronic (ERAs) and hardcopy (EOBs) remittance advices accurately across multiple billing platforms. Reconcile remittances with bank deposits on a daily basis. Escalate payment or remittance issues as needed to leadership.
• Customer Service Representative: Respond to incoming patient billing inquiries with professionalism and accuracy. Update and verify patient demographic and insurance information during account interactions. Collect guarantor balances by initiating outbound calls, processing credit card payments, and establishing and monitoring monthly payment arrangements. Reconcile payment batches at the end of each business day. Update patient accounts affected by bankruptcy status.
• Insurance Collections & Accounts Receivable: Collect outstanding insurance claims for assigned payors. Research denials and refile corrected claims; research unprocessed claims for resolution. Monitor reimbursement for assigned payors to ensure contracted fee schedules are being followed. Report issues with claims processing such as bundling, charge limits, or other irregularities.

General Responsibilities

• Collaborate effectively with all team members, Team Leads, and the Director of Revenue Cycle. Provide support to Data Entry, Customer Service, and other departments as directed. Maintain access to all systems and platforms required for assigned coverage areas. Adhere to HIPAA regulations and all PGL confidentiality and compliance standards. Maintain a high degree of mental alertness and good judgment in establishing priorities. Recognize and escalate problems to Team Leads and/or management for timely resolution. Perform other duties as assigned.