Billing Specialist

Job Description

Job Description

Description :

Responsible for helping coordinate the billing, cash posting, and collection of outstanding accounts in the Business Office. Provides assistance and backup for the Revenue Cycle Director.

• Prepare billing files to send electronically, checking for accuracy. Document accounts. Verify files were received by SSI. Keep applicable spreadsheets with totals.
• Prepare hard copy claims to send daily, checking for accuracy. Document accounts.
• Work on the Process Rejection Batch routine and make corrections.
• Print and work the Late Charges report.
• Compile and upload Bad Debt files to collection agency.
• Compile and upload Patient Statement files to third-party vendors.
• Compile credit balance report, verify refunds for accuracy, and process refund list. Submit it to the director for review and approval. Final approval by CFO.
• Responsible for checking each assigned payer’s remittances against the system’s expected reimbursement. Research any variances and appeal remittance if necessary. Promptly report any trends or issues to the Revenue Cycle Director.
• Aggressively work to reduce AR by following up on denials, underpayments, and overpayments.
• Work with the Reimbursement Specialist to appeal underpayments and denials.
• Work on claims denied due to no authorization, incorrect codes, improper billing, etc., to resolve them promptly.
• Review accounts for further collection, including phone calls, letters, final notices, and collection agency representation.
• Works closely with the Director on accounts that need to be assigned to agency and / or suits, including getting further approval (if required), documenting accounts, and following the next steps.
• Stays current on any updates or changes made to the computer system or other software programs, laws, or continuing education used in the hospital regarding billing or account collection.
• Sorts, responds to, documents, and files correspondence.
• Helps resolve problems, answers inquiries, and liaises with internal and external customers on patient account issues.
• Provides back-up for other positions in the department.
• Make recommendations to the Director on ways to improve efficiencies or processes for the department.
• Handles special projects as assigned by Management or any other duties assigned.
• As an employee of SHOLA, you are responsible for ensuring we comply with all federal and state privacy protection laws and regulations (HIPAA). You must recognize protected health information (PHI) that requires protection, determine when it is permissible to access, use, or disclose PHI, and reduce the risk of impermissible access to, use, or disclosure of PHI.
• Exceptional patient satisfaction is the expected culture at SHOLA. Each employee is responsible for delivering exceptional patient satisfaction in all encounters with patients, families, and visitors. You are responsible for always holding yourself and your peers accountable for providing excellent patient satisfaction.

The statements mentioned above outline the general duties necessary to describe the essential functions of this position. However, they are not meant to be considered a comprehensive description of all the work requirements that may be inherent in the position.

Requirements :

Education : A high school diploma or equivalent is required, and a college degree in a business-related field is preferred.

Experience : At least three (3) years of experience in a medical business office environment performing billing, payment posting, follow-up, and collections is preferred.

Licenses / Certificates : None

Special Skills : Knowledge of complete revenue cycle processes, including billing government programs such as Medicare and Medicaid, commercial payers and other third parties and patients, reimbursement from all payers, contract evaluation for proper payment adjudication and patient responsibility, and denial management. Must know medical terms, CPT / HCPCS codes, ICD-10 codes, etc. Excellent communication skills, including written, spoken, and listening skills, are essential. Must be a “team player” and be able to teach skills to others. Must have excellent interpersonal and organizational skills and can always work positively and professionally. Must possess good time management skills, problem-solving, and critical thinking skills. Must be proficient in Excel and Word. Knowledge of Meditech, SSI, Passport, and other systems related to the job is a plus, as well as the ability to understand and apply state and federal healthcare billing laws and regulations.

Reports To : Revenue Cycle Director

Positions reporting directly to this position : None