Billing and Collections Specialist

Summary:

The Billing and Collections Specialist must be customer service oriented, detail oriented in accounts receivable with insurance companies and self-pays, and able to manage multiple tasks daily.

• Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller.
• Correct claim issues and rebill claims to third-party payers within the timely refiling guidelines of the insurance company assigned.
• Write appeal letters.
• Communicate with front desk staff, nursing, and providers to ensure appropriate collection of co-pays and self-pay balances prior to patient visits.
• Contact patients after obtaining authorization to discuss collection of out-of-pocket expenses prior to visits.
• Document the appointment desk, call guarantors, and communicate balances to be collected.
• Handle inquiries and provide timely answers to questions from clerical staff, clinical staff, and insurance companies (within 24 hours).
• Monitor daily assigned insurance ARs, delinquent self-pay accounts, and all assigned work queues.
• Meet deadlines for completing all assigned work queues prior to month-end.
• Identify and resolve patient billing questions in the office and via incoming calls to the business office.
• Daily collection and posting of payments from insurance companies and patients as assigned.
• Review accounts and make recommendations regarding non-collectible accounts when working delinquent and collection accounts.
• Notify manager of non-collectible self-pays and insurance balances.
• Verify patient eligibility through various third-party sources and understand patient benefits, including in/out-of-network status prior to visits.
• Document payments collected, AR, and phone-call resolutions in the software system.
• Monitor fee schedules and inform management of changes and effective dates in a timely manner; monitor policy changes for all assigned carriers.
• Answer business office phone calls daily on a rotating weekly schedule and explain out-of-pocket expenses to guarantors.
• Assist in enrollment and explain drug rebate programs and patient assistance programs as needed.
• Assist patients in completing paperwork and follow up on patient assistance programs when needed.
• Communicate effectively with professional staff and patients.
• Monitor the personal business office phone line, calls, and emails daily; ensure voicemails are returned within 24 hours.
• Respond to emails and staff messages from manager, staff, and patients within 24 hours.
• Process daily collection of business office mail and route to appropriate billers; file manually posted payments.
• Cross-train to fill in for other functions on an as-needed basis.
• Additional duties as assigned by management.

• Associate’s degree, or equivalent, 3–5 years related experience, or Medical Billing Certification.
• Experience with medical payers including Medicaid, CMOs, and Commercial insurance.
• Working knowledge of medical billing systems, particularly Epic.
• Working knowledge of CPT and ICD-10 coding systems.
• Ability to research and resolve AR disputes.
• Customer service oriented; productive, dependable, self-starter; excellent organizational skills.
• Proficiency in Microsoft Office Suite; excellent verbal and written skills.
• Knowledge of medical billing/collection practices; strong keyboard skills.
• Ability to work under deadlines; multi-tasking; work independently and in a team; strong analytical skills.
• Capable of making timely, independent decisions.

Ethics – Treats people with respect; keeps commitments; integrity in actions.

Customer Service – Manages difficult situations; responds promptly; seeks customer feedback to improve service.

Interpersonal Skills – Solves conflicts, maintains confidentiality, listens well, stays open to new ideas.

Organizational Support – Follows policies; completes tasks on time; supports diversity and organizational goals.

Teamwork – Balances team and individual responsibilities; values feedback and builds morale.

• Frequent sitting, grasping, and speaking.
• Occasional reaching, bending, and stooping.
• Frequent use of computer, keyboard, copy/fax machine, and phone.
• Possible exposure to infectious specimens (blood or bodily fluids); may require PPE.
• Typically quiet to moderate noise level; fast-paced environment with occasional high-pressure or emergent situations.
• Work hours subject to office needs to ensure coverage during all hours of operation.