Job Details
Qualifications
- Associate's degree
- Communication skills
- Computer skills
- Customer service
- EDI
- High school diploma or GED
- Medical collection
Benefits
- Dental insurance
- Employee discount
Job Description
INSTRUCTIONS FOR APPLYING: Candidate must provide all information requested on the application page. Follow instructions carefully when preparing and uploading information. Please submit Resume and Cover Letter as PDF files only to ensure readability. All materials must be written in English. Resumes must include employment history with dates of employment and include details that show how you as a candidate satisfy the requirements of this position (degree, certifications, Alaska License Numbers, etc.). Candidates selected for potential interview should expect the possibility of further employment testing.
Position Overview
The Billing Specialist is responsible for timely and accurate billing and collections of patient accounts. The Billing Specialist performs complex clerical and accounting functions for patient billing including verification of authorizations, public and private insurance claims processing, tracking and follow-up of outstanding balances. The Billing Specialist works with others in a team environment and regularly interacts with patients.
Roles and Responsibilities
Billing:
Processes and submits timely (within 14 days of provider signature) electronic and paper claims to all payers
Confirm all required pre-authorizations/certification are present and valid, and attached to claims prior to submission.
Review Coordination of Benefits and payer sequencing to confirm accuracy prior to submission.
Maintain compliance with billing practices, policies and procedures, and rules stipulated by, but not limited to: HRSA’s Bureau of Primary Health Care, Alaska Medical Assistance, Centers for Medicare and Medicaid (CMS), Veteran’s Administration, IHS Purchased-Referred Care (PRC), Alaska’s “Ladies First” program, third-party payers, auto-liability, Workman’s Compensation, private pay, and the Kenai Peninsula School District.
Submit additional documents, such as a W9, to insurance payers as requested.
Efficient and timely submission of claim corrections and resubmissions.
Verify accurate posting of payments and adjustments to patient accounts, including any applicable discounts.
Process claims and track to clearinghouse.
Process refunds for patient and insurance credits/overpayments per applicable policies and procedures.
Research denials and zero payments, respond to inquiries and requests as needed.
Collections:
Obtain insurance EOB/EFTs and post all payments and denials or rejections by the 15th of each month. Manage denials through submittals or appeals. Investigate and analyze credit information within established guidelines. Communicate discrepancies with payer.
Review and apply sliding fee discount program adjustments to patient accounts.
Review patient statements for accuracy and send statements in accordance with SVT policies and procedures.
Maintain patient payment records, posting all payments as they are received.
Coordinate, manage and process monthly patient payment plans and connect patients with Patient Benefits Coordinators assistance as needed.
Identify non-payors, prepare and submit uncollectible balance documentation to management for approval prior to submitting to collection agency or writing off. Make account adjustments as approved.
Timely review and processing of refunds to patient accounts and insurance companies in compliance with standard billing practices, SVT policies and procedures, and rules stipulated by payers.
Reconcile end-of-month EFT deposit ledger provided by CFO.
Reconcile and correct PRC errors, resubmit claims for payment.
Process billing record requests.
Identify and process Secondary and Tertiary insurance claims for submission with primary EOBs.
Accounts Receivable:
Work with the Revenue Cycle Manager to ensure the Charge Master is reviewed and updated on an annual basis.
Perform an annual update in the EHR of the Federal Poverty Guidelines.
Coordinate with billing team to complete a monthly review of outstanding claims. Follow up and resolve unpaid claims and report known issues to supervisor.
Perform collection activities including contacting payers, patients and guarantors by phone, email and mail.
Perform monthly audit review of laboratory and diagnostic imaging invoices, coordinate payment with Accounts Payable, and/or coordinate needed corrections prior to payment. Accurately post amounts due to patient accounts after sliding fee discounts have been applied as appropriate.
Other Duties:
Provide excellent customer service to patients, internal and external stakeholders.
Work collaboratively with Revenue Cycle team members to gather and provide information on billing, authorization and eligibility issues.
Provide training to Patient Service Representatives as it applies to billing and collections.
Check and respond to billing department phone messages in a timely manner.
Maintain quality results by following established policies and procedures.
Share knowledge of current regulations, policies and developments with team members and other stakeholders.
Cross-train in essential functions to provide co-worker back-up when needed.
Assist Revenue Cycle Manager in implementing and maintaining Electronic Data Interchange (EDI) systems as requested.
Maintain strict confidentiality with regard to all client information. Adhere to all HIPAA guidelines/regulations.
Demonstrate a strong commitment to performance accountability.
Respond to inquiries regarding patient billing and account related matters.
Proactively seek out opportunities to improve knowledge, skills and performance.
Attend relevant webinars and training sessions as specified by the Revenue Cycle Manager.
Participate on staff committee(s) as assigned.
Other duties as assigned by the Revenue Cycle Manager.
Specifications
Extensive computer use required. Knowledge of electronic health records, billing software programs (preference for eClinicalWorks). General knowledge and navigation of the internet, insurance websites, email, and office equipment for copying, faxing, printing and scanning.
Knowledge of medical and dental billing and accounting procedures and applications.
Possess excellent, professional customer service skills, both verbal and written communication.
Must be able to multi-task while maintaining accuracy and attention to detail.
Must be tactful and assertive in order to successfully navigate patient collections and payment issues.
Requires hand-eye coordination, manual dexterity, and sight sufficient to operate keyboard and other office equipment.
Must be able to listen well in order to understand and be empathetic to patient concerns.
Job Requirements
Education:
Required HS Diploma or GED.
Preferred Associate’s Degree (two year college or technical school) Preferred, Field of Study: Finance/Accounting, and/or American Association of Healthcare Administrative Management (AAHAM) Certified Revenue Cycle Specialist (CRCS).
Experience:
2 plus years of experience in billing/collections or related field
Travel Required: None