Job Description

Position Summary

The Billing Specialist will be responsible for ensuring claims for patient services are accurately and timely filed and paid for his/her specified payer panel. The Billing Specialist will collect and enter claim information and post insurance and patient payments. Subsequently, he/she will work collaboratively with other members of the organization to maximize accuracy, efficiency and promptness of the claim life-cycle.

Essential Duties and Responsibilities

Claim Management -  Responsible for primary and secondary claims process from submission to payment.

• Submits clean claim to clearinghouse or insurance company electronically or via paper CMS-1500 form.
• Follows up with insurance company on denials or rejected claims. Resolves issue and resubmits claim.
• Documents denial and rejections and provides input on procedure changes to ensure accuracy and efficiency.
• Prepares appeal letters and submits appropriate documentation to substantiate appeal.
• Ensures electronic and manual payments are properly posted in medical claim billing software.

Clean Claim Verification - Assures claims are clean and ready to file for assigned payer panel.

• Resolves duplicate ticket issues.
• Reviews chart documentation for correct coding and additional revenue opportunities
• Ensures accurate use of modifiers.
• Reviews demographic and patient insurance information for completeness
• Corrects minor issues.
• Initiates communication needed to resolve claim issues, monitors until issues resolved, escalating as needed.

Patient Customer Service - Effectively communicates patient balances.

• Responds to patient inquiries.
• Assists with processing patient statements for charges not covered by insurance.
• Assists with processing past due balances to collection agency.

Workflow Analysis - Measure accuracy, quality of work output and compliance with Advance established policy and procedures related for assigned payers.

• Maintain system for tracking and reporting claim errors by individual and site.
• Maintains reporting of point of service and daily deposit collections by individual and site.

Supervisory Responsibility

• None

Education and Experience

• High School diploma or GED required.
• Two years of experience in billing operations, preferably in a healthcare facility.
• Demonstrated billing coding knowledge in order to adequately process billing and communicate effectively with providers.
• Demonstrated efficient keyboarding (data entry and typing skills).

Preferred Skills

• Knowledge of FQHC billing.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Tasks, duties, and responsibilities, as listed in this position description, are not exhaustive. The Organization, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills and/or education will also be considered, so qualifications of incumbents may differ from those listed in the Position Description. The Organization, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms.

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