Job Description

Under the general direction of the Billing Services Manager, the Director of Business Services, and the Physician Practice Business Office Supervisor, the Practice Billing Specialist will create claims, bill payers, review EOBs, post payments and provide all follow up work necessary for account reimbursement, including appeals, patient responsibility statements and collection efforts. Additionally, the position may require communication with providers regarding missing information or coding issues.

STANDARDS OF PERFORMANCE

• Prepares and submits clean claims to various insurance companies either electronically or by paper.
• Answers questions from patients and Insurance companies.
• Identifies and resolves patient billing complaints.
• Prepares, reviews and sends patient statements
• Evaluates patient’s financial status and establishes budget payment plans.
• Follows and reports status of delinquent account
• Makes recommendations for delinquent accounts to be forwarded to collection agencies.
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
• Processes payments from insurance companies
• Translates patient information into alphanumeric and numeric medical codes
• Monitors codes and educates staff on appropriate usage
• Investigates and corrects rejected and denied claims
• Participates in educational activities and attend weekly, monthly and quarterly staff meetings
• Maintains strict confidentiality and adhere to all HIPAA guidelines and regulations

Requirements

JOB QUALIFICATIONS:

Minimum Level of Education: High School or equivalent completion

Formal Training: Working knowledge of commercial insurance and government payers

Licensure, Certification, Registration: Not required, but Biller Certification preferred. Coding experience a plus.

Work Experience: Two years hands on experience in a practice billing setting, with proven organizational and follow up skills. RHC billing experience and familiarity with ACOs and associated quality standards is a plus.

Tools and Equipment Used: eCW EHR , Cerner HER, SSIGroup and Gateway/Trizetto software systems, calculator, personal computer, telephone, facsimile machine, paper shredder, copier, printer.