Job description
The Billing Specialist position manages and executes all aspects of Third Party Payer billing and financial tracking.
Essential Functions :
- Works with CFO, Accountant and Billing Manager to facilitate accurate accounting records.
- Maintains information on billing procedures by client.
- Prepares and submits clean claims to Third Party Payers.
- Researches and resolves client billing issues with Third Party Payers.
- Communicates client status of receivables when requested.
- Follows and reports on status of delinquent accounts; has plan for collection and aggressively pursues. Documents work performed / action taken in practice management system.
- Performs various collection actions including contacting insurance companies and resubmitting claims to the Third Party Payers.
- Reviews weekly aged receivables report for accounts that require follow-up.
- Follows all insurance regulations.
- Performs daily posting of EOBs to patient accounts.
- Performs daily follow-up of claims, including resolution of any billing errors.
- Reviews patient information to determine why the claim is unpaid.
- Obtains additional information needed to appeal denied or underpaid claims.
- Processes rejections and denials to determine if the claim needs to be refilled or submitted for an appeal with the Third Party Payer.
- Processes all Third Party Payer appeal requests within the time frame required by the payer.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Excellent oral, written and interpersonal communications skills.
- Consistent and regular attendance is a requirement of the position.
Non-Essential Functions/Other Duties
:
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Performs any other tasks assigned by management
Supervisory Responsibility : Not applicable.
Travel Required : Minimal.
Physical Demands :
This is largely a sedentary role, with frequent sitting and computer keyboarding (10-key) required. Some lifting (up to 35 pounds), stooping and bending are required.
Qualifications :
Education:
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High school diploma or equivalent.
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Coursework and/or experience in medical and/or health insurance billing, medical records management.
Experience:
- At least two years of previous medical insurance, billing, or claims processing related experience.
- Experience and strong knowledge of insurance procedures, reimbursement, contracts and insurance appeal are preferred. CPT and ICD-10 certification a plus.
Skills and Competencies:
- Strong keyboarding and computer skills to include MS Office (Word and Excel) experience at an intermediate level. 10-key data entry proficiency.
- Knowledge of basic medical coding and third-party operating procedures and practices, as well as knowledge of financial concepts.
- Experience working with basic office machinery and equipment, including computers, copiers, fax machines, multi-line phone systems, etc.
- Knowledge of HIPPA privacy and security rules and regulations.
- Excellent interpersonal skills, with the ability to communicate effectively with others.
- Strong organizational skills, with the ability to multi-task and meet deadlines.
- Demonstrates initiative, with the ability to manage self and workload.
- Strong analytical and problem solving abilities. Good mathematical aptitude.
- Exemplary customer service focus, for both internal and external clients.
- Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere.
- Displays professionalism and represents organization in a professional manner.
- Ability to abide by ethical guidelines and policies, including strict adherence to confidentiality and HIPPA guidelines.
Other:
- Must be 18 years old or older.
- Every Caravel employee is expected to maintain Confidentiality, Integrity, and availability (CIA) with reference to PHI and PII data of patients, parents, employees, and vendors. It is the responsibility of each individual employee to protect and inform data breaches immediately to the Security & Compliance Officer’s.
- If any of the CIA policies are not adhered to, action will be initiated as per HR policy.
Caravel Autism Health reserves the right to modify, interpret, or apply this Job Description in any way the company desires. This job description in no way implies that these are the only duties to be performed by the employee. This job description is not an employment contract, implied or otherwise. The employment relationship remains “At Will”.
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