The Billing Specialist is responsible for working patient accounts and keeping the account receivables within department standards. This position is responsible for performing billing functions that enable and expedite collections. The Billing Specialist helps improve cash flow and participates in managing the overall health of the company’s receivables. This role is responsible for posting charges and payments in a timely manner, while ensuring documentation complies with all state and federal statutes, as well as the company’s policies and procedures.
Prepares and submits clean claims to various insurance companies either electronically or by paper with required documentation as needed. Submits monthly claims billing; follow-up, re-billing, secondary billing and correction billing of claims.
Performs various collection actions, including contacting patients by phone, correcting and resubmitting claims to third party payers.
Responsible for collecting, posting and managing account payments. Posts charges for professional clinical services. Posts payments for patient payment and insurance payments. Prepares, reviews and sends patient statements.
Account aging balances; insurance verifications, referrals and authorization. Ensures aging balances are kept within acceptable collection standards. Maintains and updates the unbilled report.
Responsible for reviewing and interpreting patient accounts as applicable. Reviews patient bills for accuracy and completeness and obtain any missing information. Makes corrections or adjustments on accounts as necessary. Reviews insurance reimbursement accuracy and appeal if necessary. Update patients file records accordingly.
Performs in depth audits on accounts to ensure proper collections. Ensures accuracy of insurance claims before billing. Identifies accounts that can be written off to bad debt.
Coordinates with other departments for corrections on the unbilled report in a timely manner.
Effectively works with assigned insurance carrier(s) to resolve billing issues.
Prepare and process request for refunds with necessary documentation and submit to supervisor for approval.
Establish and maintain strong relationships with providers, clients, patients and fellow staff. Maintain good communication link with each patient’s home-clinic personnel.
Identifies and resolves patient billing complaints. Answers questions from patients, clerical staff and insurance companies.
Works effectively with the team to determine & communicate correct billings on the account.
Participates in educational activities and attends monthly staff meetings.
Performs general office clerical work including, but not limited to, copying files, entering data and answering phones. Routes communications to appropriate personnel as needed.
Assists with incoming calls, tasks and inquiries.
Maintains patient confidentiality at all times.
Other duties or special projects assigned.
Emergency duty may be required of the incumbent that includes working in Red Cross shelters or to perform other emergency duties including, but not limited to, responses to threats or disasters, man-made or natural. Additionally, incumbents are required to perform emergency response and management duties for Palm Beach County as required.
High School Diploma or GED required. Associate’s Degree preferred.
One (1) to three (3) years experience in a health care/medical business office required. Knowledge of insurance company authorization process required.
ICD-10/CPT coding course or equivalent seminar preferred.