Business Office –Billing & Collections Specialist

Knowledge, Skills & Abilities:
The Business Office employee, under the supervision of the Business Office Director and Business Office Supervisor, is responsible for the financial success of the facility as it relates to revenue cycle management. The employee should have a full understanding of each of the processes to maximize reimbursement: collections of all payer types, billing and revenue coding, insurance benefit interpretation, authorization, admission sources, payer specific requirements, contract reimbursement, claim editing, clearinghouse processing, adjudication, and appeals/denial management. It is understood that business office clerks will change tasks from time to time to meet the needs of the business.

Behaviors/Abilities
Projects a professional demeanor and appearance while maintaining the confidentiality of patients, co-workers, and the surgery center and adhering to the HIPAA policy. Reports, in good faith, any known or suspected activity that appears to violate laws, rules, regulations or the SP Code of Conduct. Fulfills annual Competency continuing education requirements.

Personal attributes include the ability to be self-directed; demonstrates accountability, professionalism, and receptiveness to change; seeks guidance, direction, and assistance when needed. Works under stress and in situations that demand patience, stamina, endurance, and tact while providing impeccable service. Fosters an attitude of teamwork and willingness to assist others and does not refuse performing other job duties as requested within the hospital or hospital outpatient department. Set's priorities, responds timely to issues, which require a decision, and ensure desired results are achieved by means of consistent, follow through. Willingly accepts other assignments as the need arises.

Position Summary:
Responsible for all aspects of medical AR collections for a physician medical group. Will be responsible for claim denial follow up for all assigned insurance payers, resolving billing problems and answering patient and clinic inquires. Uses collection techniques to keep accounts receivable current including monitoring for delinquent payments

Qualifications:
• High School Diploma or GED
• 2+ years medical billing and/or collections experience in a physician’s or other medical facility setting
• Knowledge of governmental insurance plans (Medicare Part B and C, Medicaid and associated advantage plans, Tricare, etc.) and commercial insurances (PPO, HMO, EPO, HRA, etc.)
• Working knowledge of CPT, HCPCS, and ICD-10
• Understanding of HIPPA guidelines
• Working knowledge of Word, Excel, and Outlook
• Experience with EMR software (eClinicalWorks preferred, but not required)
• Must be able to multi-task, meet deadline and be a team player

Job Responsibilities:
• Follows up on insurance billing to ensure timely receipt of payments.
• Demonstrates the ability to professionally interact with patients and insurances companies regarding sensitive financial matters and recapture unpaid balances.
• Receives and resolves patient billing inquiries; initiates adjustment requests as necessary
• Follows up on all zero payment explanations of benefits and exercises all options to obtain claim payments
• Reviews assigned accounts on a monthly basis and reports inconsistencies and correct errors as appropriate
• Provides support for inquiries on accounts
• Researches issues and follow up with all parties
• Initiates payer and/or patient refund requests for overpayments that have been researched
• Initiates debt write off requests