Billing and Collections Specialist

JOB DESCRIPTION
Job Title: Billing and Collections Specialist
Department: Finance
Position Type: Full-Time
FLSA Status: Non-exempt
JOB SUMMARY
The Billing and Collections Specialist is goal-oriented, revenue-driven, highly accurate and motivated employee. Primary duties include, but are not limited to: consistently follow up on unpaid claims, utilizing monthly aging and financial reports, managing rejections, and filing appeals when appropriate to obtain maximum reimbursement. Other duties include but are not limited to: data entry of all patient demographic, guarantor and insurance information, posting charges for services, managing submission of claims to insurance, posting insurance/patient payments, and balancing payments to daily deposits.
ESSENTIAL FUNCTIONS

1. Bills and ensure all claims are submitted within the goal of 2 business days from date of service with a goal of zero errors (“clean claims”)
2. Verifies completeness and accuracy of all claims prior to submission
3. Accurately post all charges and insurance and patient payments by line item
4. Timely follow-up on insurance claim denials, exceptions, or exclusions
5. Meet department deadlines for Billing and Collections process and KPI’s
6. Read and interpret insurance Explanation of Benefits (EOB’s)
7. Manage payer Single Case Agreements (SCA’s) and out-of-network payment negotiation attempts using standards to optimize reimbursement
8. Utilize monthly aging accounts receivable and financial reports in Electronic Health Record (EHR) to follow up on unpaid claims aged over 30 days
9. Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies
10. Submit and manage appeals (submitted to insurance) for claims that did not process
11. Respond to inquiries form insurance companies, patients, and providers
12. Regularly meet with Management team to discuss and resolve reimbursement issues or billing obstacles
13. Communicate claim processing trends to management team
14. Regularly attend staff meetings and continuing educational sessions as requested
15. Perform additional duties as requested by Supervisory or Management team

REQUIRED SKILLS

• Computer experience is essential, including, but not limited to: practice management software, word processing and spreadsheet applications.
• Experience in CPT, HCPCS, Revenue, and ICD-10 coding; familiarity with medical terminology.
• Experience working with professional and institutional insurance claims.
• Excellent customer service skills.
• Strong written and verbal communication skills.
• Ability to manage relationships with various Insurance payers.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
• Responsible use of confidential information.
• Perform to industry production standards.
• Maintain compliance with company policies and procedures.
• Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients.

SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
COMPETENCIES
To perform the job successfully, an individual should demonstrate the following competencies:

• Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.
• Customer Service – Answers and responds to issues as they arise.

• Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods.
• Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.
• Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values.
• Judgement - Displays willingness to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Language Skills
Ability to read, analyze, and interpret financial reports, and legal documents. Ability to respond to common inquiries or complaints from employees or members of the business community.
Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills
To perform this job successfully, an individual should have knowledge of Microsoft Office (Word, Excel and Outlook) as well as google mail and QuickBooks.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this Job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk and sit. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and distance vision.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
The noise level in the work environment is usually moderate.
WHY INFINITE RECOVERY?
• Generous salary
• Medical, dental, and vision plans with the portion of employee paid for by company
• 2 weeks of paid time off a year to spend however you want and 7 paid holidays
• Infinite Recovery contributes a percentage of your total 401k contributions each year towards your retirement fund