BILLING COLLECTIONS SPECIALIST

US:NV:Carson City Patient Financial Services

Full Time Standard Office Hours

Summary

Ensures the continuity and accuracy of claim submission through the patient accounts electronic billing and payment system. Maintains a working knowledge of business operating systems including electronic billing system and Receivables Work Station. Complies with State & Federal regulations with regard to billing. Processes insurance remittance and correspondence to ensure claims are processed correctly and patients are billed accordingly. Maintains productivity standards and reports billing issues appropriately. Accumulates data relating to patient accounting billing processes in an effort to identify areas of opportunity and make recommendations.

Qualifications

Required

• High school diploma (or equivalent)
• Two (2) years' experience in a healthcare setting
• Knowledge of billing guidelines for government and/or commercial payors
• One (1) year experience with Microsoft Office (Outlook, Word, Excel)
• Knowledge of medical terminology, anatomy/physiology

Preferred

• Acute Care Billing Experience
• Three (3) years healthcare service experience
• Experience

Essential Functions

• Reviews and determines claims appropriate for electronic billing; submitting accurate claims daily through the electronic and payment applications based upon appropriate protocol and edits for payer.
• Manually mail claims where electronic filing is not available and attaching necessary documentation.
• Fulfills incoming insurance correspondence via mail
• Documents all patient account(s) activities concisely, including future steps needed for resolution.
• Contacts payers to determine reasons for outstanding claims and communicates with payers to facilitate timely payment of claims
• Investigates any overpayments and underpayments and reaches out to payers when necessary to follow up on pending or delayed claims
• Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R
• Processes all claim edits and deletions to ensure minimal volume of accounts are held for smooth cash flow.
• Reconciles and submits rejected claims within the same working day.
• Maintains failed claims daily by researching and resolving issues for clean submission.
• Demonstrates an understanding of Patient Accounts key performance indicators.
• Receives incoming insurance telephone calls, providing requested information in a timely, courteous and professional manner.
• Monitors and works the claims on hold ensuring needed information is received from departments within 24 hours.
• Appropriately escalates any delays in receiving needed information to correctly submit claims.
• Monitors and submits special services billing per service/payer or regulatory guidelines.
• Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA)) as well as facility-specific guidelines.
• Performs complete follow-up on claims daily and monitors trends in payer performance, reporting such trends to Supervisor/Manager.
• Collaborates with other departments within in the organization to obtain information relevant to successful collection of reimbursement for all accounts.
• Participates in staff training that aligns with recognized improvement opportunities and increased understanding of hospital and professional billing requirements.
• Demonstrates thorough understanding of reimbursement as it relates to payer contracts.
• Performs other related duties as assigned.