This position is hiring for a Billing Specialist- Accounts Receivable. It is a hybrid position after successful completion of training.
Position Summary : Under the direction of the CBO Director, the employee is responsible for the collection of unpaid claims and appeals, understanding insurance EOB’s, processing insurance and patient refunds, posting of insurance and patient payments, understanding all aspects of coding, quality assurance and compliance with Federal Payer documentation guidelines. This position will work A/R follow-up primarily and cover all positions for PTO coverage.
Reports to: The Billing Float reports directly to the CBO Director
Flexibility: While this job description is meant to provide an overview and specific responsibilities of the Billing Float, ENTA Management reserves the right to make changes, adjustments, and revisions, as needed, to this document and will coordinate such modifications with ENTA’s Practice Administrator and Physicians. While the normal work week is 40 hours, you may be subject to overtime (not to exceed 50 hours per week).
Summary of General Duties:
- Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
- Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer contract.
- Review and update patient registration information (demographic and insurance) as needed.
- Applies appropriate discounts/courtesies based on department policy.
- Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up workflow.
- Prints and mails claim forms and statements .
- Retrieves supporting documents (medical records, authorizations, etc.) as needed and submits to payers.
- Appeals reflected claims and claims with low reimbursement.
- Confirm credit balances and gather necessary documentation for processing refund.
- Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issues causing non-payment of claims.
- Monitor invoice activity until the problem is resolved.
- Process daily mail, edits reports, file or pull EOB batches.
- Identifies and informs Lead and Director of issues or problems associated with non-payment of claims.
- Contact payors or patients as appropriate for corrective action to resolve the issues and receive payment of the claims.
- Other assistance to the billing staff as needed which may include posting insurance and patient payments, posting of charges, patient collections, answering patient and insurance calls.
- Maintain patient confidentiality.
- Knowledge of billing/coding
- Scanning documents into charts
- BayCare interface
- Usage of all online insurance websites including uploading documentation and processing appeals electronically.
- Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
- Serves as departmental expert on coding questions.
- Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with polices.
- Research and answers billing and documentation questions or problems, submitted by staff, billing staff, and others to ensure compliance with specific payer regulations.
- Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P Consults, ER Consults, Surgeries, medical records.
- Review and resolve Encoda charge review edits daily.
- Charge Entry.
- Maintain and movement of payments from credit to line-item charges, ensuring patient credit balance accuracy.
- Completes daily and month-end closing.
- Retrieve and upload sleep studies and operative notes from BayCare system.
- Maintaining and clearing of exceptions in the Encoda Payment Manager dashboard daily.
- Daily review of outstanding checks, calling payers to identify delays and/or processing a replacement check.
- Reviewing and completing the weekly statement reports to ensure any monies are moved to avoid unnecessary statement delivery to patients.
- Posting of all payments and rejections (manual & electronic) in Prime Suite.
- Processing and Handling of all patient and insurance refunds.
- Updates patient demographics for insurance related issues in order to accurately process claims.
- Investigating and updating any returned patient statements via mail.
Working Environment:
- Physical demands:
- Average percent of time during regular shift devote to:
- Walking, Squatting, Sitting, Bending, Reaching: 75%
- Standing: 25%
- Average lifting requirements:
- Lifting Requirements: 20-40 lbs.
- Frequency of Lifting: 0-25% of the time
- Additional physical demands:
- Ability to grasp with both hands; pinch with thumb or forefinger; turn with hand/arm; reach for (above shoulder height).
- Ability to type 60 wpm.
- Ability to operate multi-line telephone system, computer keyboard and ten-key adding machine.
- Visual, Hearing, and Mental demands: Vision adequate to perform essential functions such as read telephone displays/computer terminals for long periods of time, correctable to 20/20. Hearing is adequate to perform essential functions such as answering the telephone. Mental capacity adequate to perform essential functions such as quickly and accurately entering patient demographics and scanning documents while checking in multiple patients. Tact to deal with unfriendly individuals regarding various situations, and adequately handle stress.
- Working Conditions: Normal business office environment. Requires individual to be in uniform daily. Required to exhibit a positive attitude and a professional appearance and show great detail and accuracy. Required to exhibit quality performance of the essential job functions to help the office run effectively and efficiently.
Position Requirements:
- High School education or GED equivalent.
- Minimum 2 years of medical billing experience required.
- Proficient in Microsoft Outlook, Microsoft Word/Excel, computer knowledge to navigate internet websites such as Availity, Navinet, etc.
- Ability to communicate effectively with patients, physicians, and staff in a courteous manner.
- Ability to use time wisely in preparing work area to meet high-paced demand.
- Show a genuine desire to work and improve the practice.
- Basic coding knowledge
- Strong medical terminology
- Must demonstrate excellent phone etiquette and exceptional customer service skills.
- The ability to attend work on a regular basis.
- The ability to adhere to safety rules and other reasonable regulations pertaining to the job.
- The ability to refrain from negativity or excessive irritability.
- The ability to work in cooperation with other workers.