Reimbursement Specialist; Medical Billing

SUMMARY: Under the general supervision of the Director of Business Office Services, the Reimbursement Specialist is responsible for timely billing functions, including posting of charges, electronic and paper insurance billing, and collecting accounts receivables. The Reimbursement Specialist also conducts training, serves as a primary resource for billing system changes, responds to patient inquiries and resolves problems with third party payors.

• Business Office Duties
  • Registers new patients, obtains appropriate insurance and billing information, and updates information as needed.
  • Explains billing policies/procedures and insurance benefits to patients.
  • Generates documentation for patients with private cancer insurance policies as needed.
  • Responds to patient inquiries (on-site visits and by phone), including researching relevant information, contacting payors on behalf of patients, and informing patients of the outcome.
  • Serves as a resource person for physicians, staff and patients/family/significant others regarding insurance and billing issues and questions.
• Reimbursement Duties
  • Codes procedures and diagnosis. Reviews charts and abstracts data from patient records for documentation to support charges and services, analyzes source documentation to determine diagnoses, and selects codes for optimal reimbursement.
  • Posts charges for services, including charges for office visits, physician services, laboratory testing, treatments, etc. Reviews encounter form, nurse notes, and pharmacy lists for completion, enters charge ticket data, batches charge tickets, files completed batches, and posts charge adjustments.
  • Processes a variety of insurance billing, including primary, secondary and third party payors. Verifies claim status, electronically submits claims, sorts paper claims according to third party payor, attaches required documentation and submits claims to appropriate payor locations.
  • Receives and posts payments and adjustments, including receipts from insurance groups, patients, and other organizations. Sorts payment receivables, reviews EOBs and RAs for payments and adjustments, posts line item payments to corresponding charges. Responsible for balancing receipts and bank deposits.
  • Reviews returned, disputed or rejected claims and resolves claim problems with third party payors. Generates aged account reports, follows up with payors for claim status, provides requested information and clarifies documentation, and submits revised claims as necessary. Reports unresolved accounts to the supervisor.
  • Reviews patient account to ensure monthly statements are mailed to the patient. Pre-screens patient balances for collection agency placements.
  • Analyzes patient aged accounts. Generates aged patient account reports, reviews past due accounts, contacts patients to request outstanding balances, and documents patient payment arrangements. Reports unresolved accounts to the supervisor.
  • Maintains a working knowledge of CPT-4, ICD-9 / ICD-10 CM, and HCPCS coding systems, governmental regulations, protocols and third party requirements, as well as compliance issues, related to billing and billing documentation.
• Professional Communication
  • Maintains confidentiality in matters relating to all aspects of employment, including patient/family/significant other confidentiality.
  • Interacts with patients/family/significant others with a variety of developmental and sociocultural backgrounds.
  • Maintains professional relationships and conveys relevant information to other members of the health care team.
    • Internal Contacts:
      Physicians, nursing staff, laboratory staff, pharmacy staff, office staff, other Business Office staff, etc., and staff at other CCSI facilities.
    • External Contacts:
      Insurance representatives, Medicare representatives, coding specialists, hospitals, other physician offices, hospice staff, etc.
  • Relays information appropriately over telephones, facsimiles, e-mail, and other communication methods, and follows-through as needed.
  • Communicates appropriate information to physicians, supervisors, and/or other members of the healthcare team as needed, and follows-through on physician orders…