Job Description

Position Summary:

The Billing Specialist contributes to the viability of the organization by assuring that all patient accounts have been properly billed and collected in a timely manner. This position is responsible for contacting the appropriate third-party payor to secure and expedite unpaid claim payments through the follow-up and appeals resolution processes. Work situations are varied and require extensive billing, follow-up and appeal knowledge, along with strong customer service skills. In addition, this position will be responsible for all incoming telephone calls into the Business Office including those from patients, providers and third-party payors. Requests for medical record copies will also be managed by this position when the need is urgent and Medical Records Specialist is unavailable.

Qualifications:

Education/ Experience: High school graduate or equivalent. Billing certification or equivalent preferred. Excellent communication skills. Advanced computer knowledge, data entry skills. Knowledge of inpatient and outpatient workflows and processes

Other Requirements: Ability to work independently, pay attention to details, multitask, and follow set procedures.

Requirements

Essential Functions Of The Position:

• Achieves resolution on claims for payment from third party payor sources utilizing established policies and procedures.
• Work queues (such as technical denials, at risk claim, EOB variances and credit balances) within the revenue cycle module in the EMR for follow up on all unpaid third-party payor claims.
• Interacts with third party payors to obtain payment for pending or rejected claims.
• Executes the re-billing of claims if required by third party payors.
• Documents all follow-up activities on accounts within the patient accounting in the EMR.
• Performs the billing function on all late charge and secondary payor claims.
• Answers incoming calls from patients, hospital and clinic staff, and third-party payors.
• Resolves patient billing complaints.
• Responds to correspondence in a timely manner.
• Provide feedback to the Business Office Director on claim denials.
• Provides medical record copies to patients, provider offices and third-party payors upon presentation of valid record release forms when Medical Record specialist is unavailable.
• Maintains a familiarity with Critical Access Hospital/ Rural Health Clinic regulations.
• Maintains a healthy cooperative professional working relationship with all staff including but not limited to medical staff, other departments, as well as outside agencies, community members and our patients.
• Maintain a thorough understanding of third party payor billing regulations.
• Answers the phone and incoming faxes.
• Performs other duties as assigned.