Billing, Billing Records, Communication Skills, Cross-Functional, Documentation, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, High School Diploma, Insurance, Insurance Claims, Maintain Compliance, Medicaid, Medical Record System, Medical Terminology, Medicare, Negotiation Skills, Problem Solving Skills, Quality Metrics, Reconciliation, Regulations, Team Player, Third-Party Payer, Time Management, Trend Analysis
POSITION TITLE: Billing Specialist
DEPARTMENT: Revenue Cycle
NATURE OF POSITION: The Billing Specialist will research and review accounts to assure accurate patient balances, set up payment plans on patient balances and conduct follow-up on accounts.
MINIMUM QUALIFICATIONS:
- High School graduate or equivalent required
- Ability to work and communicate with multidisciplinary health care team
- Ability to understand insurance terms, and payment methodologies, and effectively
negotiate with customers when required
- Must be familiar with medical terminology
- Ability to work in a fast paced, high volume, and high stress environment
- Must be able to sit, stand, walk, bend, and/or lift for extended periods of time
RESPONSIBILITIES:
- Prepares and submits accurate insurance claims (electronic and paper) to
commercial, Medicaid, Medicare, and other third-party payers.
- Monitors claim status and follow up on unpaid, denied, or rejected claims in a timely
manner.
- Investigates and resolves claim denials, rejections, and payment discrepancies.
- Prepares and submits corrected claims, appeals, and supporting documentation as
needed.
- Posts insurance payments, adjustments, and explanations of benefits (EOBs)
accurately to patient accounts.
- Communicates with insurance companies to resolve billing issues and obtain claim
status updates.
- Works closely with providers, coding staff, and office personnel to resolve billing and
documentation issues.
- Identifies trends in denials or underpayments and reports issues to management.
- Maintains up-to-date knowledge of payer requirements, policies, and regulatory
changes.
- Ensures compliance with all federal, state, and payer-specific regulations, including
HIPAA.
- Maintains accurate and complete documentation of all billing activities in the
EHR/EPM system.
- Meets productivity and quality standards for claim submission, follow-up, and
resolution.
- Participates in ongoing training and education related to billing, coding, and
compliance.
- Performs other duties as assigned.
ORGANIZATION:
- Exhibits enthusiasm, a positive attitude, and professionalism in the workplace
- Handles personal conflict and works through it at the lowest possible level (first with
party/parties involved, then, if necessary, with 3rd party mediation)
- Displays a friendly manner and is easy to approach
- Maintains a neat, clean, well-groomed, appearance and dresses in accordance
with the dress code policy
- Leaving personal problems out of the workplace
- Treats all co-workers with dignity and respect
- Abstains from gossip in the workplace
- Arrives on time and work through designated hours
- Completes tasks effectively, accurately and on time
- Demonstrates little or no absenteeism/follows leave guidelines
- Follows designated line of support
- Display a willingness and flexibility to respond to unusual job-related demands
- Manages time well
- Recognizes and assists others in the work of the department, even though the work
may be outside of regular duty.
- Shares equally in the workload of the department
- Works cooperatively with all team members and departments
- Works independently requesting assistance from supervisor only as needed
- Abstains from criticizing COFMC, colleagues and supervisors
- Demonstrate loyalty to COFMC, colleagues and supervisors
- Demonstrates support of the mission and vision of COFMC
- Accepts and participates in cross training
- Takes initiative to identify skill development needs
- Commitment to the mission of COFMC.
C
Central Oklahoma Family Medical Center