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Job Title:Billing Specialist
Department: Business Office
Reports to: Business Office Supervisor/Revenue Cycle Manager
Organizational Peers: Business Office Staff
Supervisory Responsibilities: None
Position Details: Non-Exempt, Full Time, 40 hours/week
Pay Scale: $20-24/hr
Summary of Duties:Responsible for gathering charge information and entering into the data base, completing all of the billing processes, filing insurance claims, and working the aged accounts.
Essential Job Responsibilities:
Performance Requirements:Knowledge:
Skills:
Abilities:
Education: High school graduation or GED.
Experience: Preferred minimum of one year billing experience in health care organization
Job Title:Billing Specialist
Department: Business Office
Reports to: Business Office Supervisor/Revenue Cycle Manager
Organizational Peers: Business Office Staff
Supervisory Responsibilities: None
Position Details: Non-Exempt, Full Time, 40 hours/week
Pay Scale: $20-24/hr
Summary of Duties:Responsible for gathering charge information and entering into the data base, completing all of the billing processes, filing insurance claims, and working the aged accounts.
Essential Job Responsibilities:
- Reconciles account receivable claims using Athena Health electronic health records (EHR)
- Reconciles outstanding balances to determine appropriate course of action for various payers including Medicare, Medi-Cal, Worker's Comp.
- Traces and appeals underpaid, and/or erroneously paid or denied claims with appropriate documentation according to the payer requirements.
- Verifies and adjusts accounts according to payer or program specifications.
- Performs collection actions and resubmits claims to insurance companies after corrections to minimize days in accounts receivable.
- Accurately documents claim issues.
- Prepares adjustments such as refunds, contractual differences, and write-offs for approval and processing.
- Audits, communicates and follows up with providers and staff to provide guidance in correcting errors related to denied or unpaid claims on continuing basis.
- Identifies and resolves issues with patient/payer billing issues and complaints.
- Continually strives to promote and maintain exceptional internal and external customer service.
- Monitors payer websites for medical policy benefit changes. Communicates changes to supervisor and staff.
- Reviews bulletins, newsletters and periodicals and attends workshop to stay abreast of current issues, trends and changes in laws and regulations governing claims, processing, coding and documentation.
- Provides suggestions to improve daily collection workflows and inefficiencies.
- Demonstrates working knowledge of ICD-10, CPT and HCPCS codes along with HIPAA laws and LCD/NCCI edits
- Complies with all company policies and procedures.
- Provides back up and support to team members as necessary.
- Works projects as assigned by management.
- Other duties as assigned.
Performance Requirements:Knowledge:
- Knowledge of billing practices and clinic policies and procedures.
- Knowledge of coding and clinic operating policies.
- Knowledge of medical terminology.
- Knowledge of insurance industry.
- Knowledge of grammar, spelling, and punctuation.
Skills:
- Skill in establishing and maintaining positive, effective, internal and external working relationships.
- Skill in written and verbal communication.
- Skills in organization.
Abilities:
- Ability to understand and interpret policies and regulations.
- Ability to prepare documents in response to complaints and inquiries.
- Ability to accurately enter data.
- Ability to examine documents for accuracy and completeness.
- Ability to read, understands, and follows oral and written instruction.
- Ability to sort and file materials correctly by alphabetical or numeric system.
- Ability to communicate effectively and work with others
- Ability to multitask.
Education: High school graduation or GED.
Experience: Preferred minimum of one year billing experience in health care organization
