Patient Billing Specialist - Closes 12/05/2023

Opening Date:November 16, 2023

Closing Date:December 5, 2023

Job Title:Patient Billing Specialist

Salary/Wage:$25.32 per hour

Tribal LevelTL 116

Location:Siletz, Oregon

Classification:Full-time, Non-Exempt

Job Posting Number: 202375

INTRODUCTION:

The Patient Billing Specialist assists in the billing and collection for all services provided at the Siletz Community Health Clinic. They will assist patients in determining eligibility for benefits and services with Oregon Health Plan, Medicare, other third party insurance’s, and Purchased/Referred Care. They will help patients in completing forms, follow-up procedures, problem resolutions, and questions regarding individual patient accounts co-insurance and co-pay issues.

DUTIES:

Check patient’s eligibility and insurance benefits for all clinic services including medical, dental, optometry and behavioral health.

• Analyze insurance payment and adjustments within patient’s accounts
• Follow-up on workman’s comp and automobile coverage.
• Audit patients accounts balances and prepare statement reports.
• Audit patient accounts for billing discrepancies compared to the insurance’s ERA/EOB and make the appropriate corrections in that account as needed.
• Serves as additional onsite support for third party billing company.
• Assist in preparation and review accounts receivable reports and periodic financial reports.
• Sign in as a as an admin/super-user of the clinic software to add or update selected database information.
• Communicate with patients and our third-party billing company regarding insurance billing concerns.
• Act as a primary contact for insurance eligibility and benefit related questions.
• Explains benefits and services covered by insurances and other third party payers to the patients and the clinic’s providers.
• Assists and answers patient concerns with explanation benefits (EOB's) and insurance denials.
• Become a certified Application Counselor/Assister in Oregon and Federal Marketplace, and provide backup coverage for the Patient Benefit Specialist.
• Run reports identifying patients that may be eligible for OHP and communicate findings to the Patient Benefit Specialist.
• Generate Reports to identify missing patient demographics’ and facilitate in the obtaining of the required supporting documentation.
• Generate Reports to identify trends in insurance payments and denials.
• Assist the Business Office Manager in creating solutions that will improve Key Performance Indicators within the Revenue Cycle.
• Create and maintain up-to-date end user guide on appropriate insurance selection.
• Corresponds with patients and insurance companies regarding outstanding accounts.
• Train clinic staff on insurance and eligibility related topics.
• Audit and test NextGen EPM and EHR system enhancements
• Generate IHS Demographic and User Population Reports
• Audit the IHS Reports and make corrections within the patient charts to insure accuracy
• Assist in processing patients payments.
• Other duties as assigned.

REQUIREMENTS:

Associates Degree in health administration area or related field and one year experience in Patient Accounts or Medical Billing - OR – an equivalent combination of specialized experience and/or education. Specialized experience is experience which is directly related to the position to be filled.

Knowledge of:

• Insurance guidelines including Medicare, Medicaid and third party insurance.
• Medical terminology, diagnosis, coding and insurance terminology, preferred.
• Regulations related to Medicare, Medicaid and commercial insurance
• Medical billing procedures, preferred.

Experience in:

• Working with medical management information systems (MMIS), third-party insurance portals, Word, Excel, and related computer applications, preferred.
• Medical, Dental, Optometry, Alcohol & Drug, Mental Health and/or Pharmacy billing, preferred.

Ability to:

• Work with a wide variety of people and able to communicate effectively to tribal and community members, staff, insurance companies as well as federal, state and local health agencies.
• Handle possible stressful situations involving explanation of insurance eligibility and benefits to patients with little or no knowledge of insurance practices.
• Plan, organizing work, and setting priorities to meet strict deadlines and fluctuating patient/client workloads.
• Meet and deal with the public. This includes the ability to establish positive interpersonal relations by exercising tact, diplomacy and mature judgment with a wide variety of individuals.
• Obtain information by asking pertinent questions, identify relevant facts, and determine complex issues.
• Demonstrate analytical skills.
• Demonstrates expertise in eligibility and enrollment rules and procedures.
• Demonstrate effective computer skills with specific knowledge of spreadsheet applications, data entry, and electronic transmission procedures.

Other:

• Must be well organized and able to handle a large volume of work.