Medicare 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.
• Submits Insurance claims, including the maintenance of bill holds and the correction of errors, to provide timely, accurate billing services.
• Researches claim rejections, makes corrections, takes corrective actions and/or refers claims to appropriate staff members for follow through to ensure timely claim resolutions.
• 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.
• Evaluates accounts, resubmits claims, performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect.
• Responds to inquiries, complaints or issues regarding patient billing and collections, either directly or by referring the problem to an appropriate resource for resolution.
• Participates in cross-training and job enlargement opportunities for major job responsibilities.
• Works with direct supervisor to identify minor set of responsibilities to develop and perform.
• Plans, organizes, and documents work to deliver business results by meeting or exceeding all individual operating metrics and service line agreement objectives.
• Follows all PruittHealth policies and procedures, state and federal laws and regulations and report violations and potential issues to his/her team leader as appropriate.
• Contributes ideas and actions towards the continuous improvement of Revenue Cycle processes.
• Affords assistance in orientation and appropriate training of team members, including helping cross-train peers in minor responsibilities and acting as a mentor to peers.
• Maintains positive work relationships with members of own and other teams to communicate effectively and ensure compliance with cross-team responsibilities.
• Carrries out all duties with a “Commitment to Caring” attitude in accordance with PruittHealth’s mission, vision, and philosophy.

Knowledge, Skills, Abilities

• 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.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of principles, methods, and techniques related to compliant