Revenue Cycle Billing Specialist

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* JOB SUMMARY:

** Manage daily billing functions for assigned patient and insurance companies.  Coordinate the interaction between patients and payors to facilitate timely reimbursement.  Serve as a point of contact for billing problem solving.  In depth knowledge of carrier Clinical Coverage Policies (CCP) and Billing Coverage Policies (BCP).
** SPECIFIC RESPONSIBILITIES:
*** Maintain Accounts Receivable KPI (A/R balances older than 120 days must be less than 19% of total A/R)
* Maintain Adjusted Collection Percentage KPI (Reimbursement/Collections equal to or above 97% of Expected)
* Review and resolve denied patient insurance claims
* Review and resolve collection accounts
* Patient Refunds
* Manage Online payment portals
* Assist in identifying current and/or potential billing issues specific to unpaid claims
* Post and balance all activity from carrier remits to include payments, contractual adjustments, and other adjustments
* Post and balance all payments from patients
* Make appropriate decisions and calls to carriers to maximize reimbursement on accounts to be worked
* Correct errors on electronic error reports
* Process and print/transmit patient insurance claims, bills and other reports.
* Respond to patient account inquiries in person, by phone, or by mail; resolve problems as necessary
* Respond to inquiries from office staff regarding patient charges, appropriate
* diagnosis coding, and insurance coverage related issues
* Respond to inquiries from employees, payers, and patients regarding CPT and ICD-10 codes
* Maintain high level of patient confidentiality
* Ensure compliance with HIPAA regulations
* This role description is a general description of the essential job functions.  It is not intended to describe all the duties the Self-Pay Billing Specialist may perform.
*** KEY

COMPETENCIES:

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* ** Communication Skills
** Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.
* ** Decision Making
** Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.
* ** Health Care Knowledge
** Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate.  This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC’s organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.
* ** Interpersonal Skills
** Showing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when its most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.
* ** Organizational Values
** Adherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.
* ** Problem Solving
** Having an analytical…