Job Title: Billing Specialist
Department: Business Office
Reports to: Business Office Supervisor/Revenue Cycle Manager
Organizational Peers: Business Office Staff
Supervisory Responsibilities: None
Position Details: Non-Exempt, Full Time, 40 hours/week
Pay Scale: $20-24/hr
Summary of Duties: Responsible for gathering charge information and entering into the data base, completing all of the billing processes, filing insurance claims, and working the aged accounts.
Essential Job Responsibilities:
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Reconciles account receivable claims using Athena Health electronic health records (EHR)
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Reconciles outstanding balances to determine appropriate course of action for various payers including Medicare, Medi-Cal, Worker’s Comp.
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Traces and appeals underpaid, and/or erroneously paid or denied claims with appropriate documentation according to the payer requirements.
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Verifies and adjusts accounts according to payer or program specifications.
- Performs collection actions and resubmits claims to insurance companies after corrections to minimize days in accounts receivable.
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Accurately documents claim issues.
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Prepares adjustments such as refunds, contractual differences, and write-offs for approval and processing.
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Audits, communicates and follows up with providers and staff to provide guidance in correcting errors related to denied or unpaid claims on continuing basis.
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Identifies and resolves issues with patient/payer billing issues and complaints.
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Continually strives to promote and maintain exceptional internal and external customer service.
- Monitors payer websites for medical policy benefit changes. Communicates changes to supervisor and staff.
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Reviews bulletins, newsletters and periodicals and attends workshop to stay abreast of current issues, trends and changes in laws and regulations governing claims, processing, coding and documentation.
- Provides suggestions to improve daily collection workflows and inefficiencies.
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Demonstrates working knowledge of ICD-10, CPT and HCPCS codes along with HIPAA laws and LCD/NCCI edits
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Complies with all company policies and procedures.
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Provides back up and support to team members as necessary.
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Works projects as assigned by management.
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Other duties as assigned.
Performance Requirements:
Knowledge:
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Knowledge of billing practices and clinic policies and procedures.
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Knowledge of coding and clinic operating policies.
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Knowledge of medical terminology.
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Knowledge of insurance industry.
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Knowledge of grammar, spelling, and punctuation.
Skills:
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Skill in establishing and maintaining positive, effective, internal and external working relationships.
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Skill in written and verbal communication.
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Skills in organization.
Abilities:
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Ability to understand and interpret policies and regulations.
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Ability to prepare documents in response to complaints and inquiries.
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Ability to accurately enter data.
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Ability to examine documents for accuracy and completeness.
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Ability to read, understands, and follows oral and written instruction.
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Ability to sort and file materials correctly by alphabetical or numeric system.
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Ability to communicate effectively and work with others.
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Ability to multitask.
Education: High school graduation or GED.
Experience: Preferred minimum of one year billing experience in health care organization