TYPICAL WORK ACTIVITIES: Performs all duties in accordance with Medicare, Medicaid, governmental and third party payer and patient self-pay billing guidelines, rules and regulations and ensures compliance with Health Information Portability and Accountability Act (HIPPA) regulations; Operates electronic billing system; Reviews patient medical bills for accuracy and completeness upon submission to payer; Contacts patients, if necessary, to obtain information and assistance in processing claims; Documents and updates patient accounts with correct and accurate information; Follows up on unpaid or incorrectly paid claims to ensure correct and timely reimbursement; Performs daily voucher breakdown to ensure timely follow-up is completed; Prepares refunds for credit balances; Prepares itemized bills and statements to be rendered; Receives payments and set-up patient payment plans as required; Analyzes and acts on system generated reports; Bills and follows-up on payer and governmental audits; Performs and monitors internal and external audits; Reviews, completes and correctly files correspondence requests; Monitors insurance denials; contacts insurance companies to resolve and recover denied claims; Evaluates unresolved third party claims and processes appeals with insurance companies to obtain proper reimbursement; Collaborates with internal and external departments to ensure correct billing practices and accurate reimbursement and to resolve billing issues; Serves as a resource for problem solving for registration, demographic and insurance errors; Tracks trends for denials and underpayments to facilitate process improvements; recommends quality and/or improvement initiatives; Receives and downloads electronic funds transfer (EFT) payments; Maintains and updates various cash logs, ensures cash received and posted is balanced, prepares daily deposit; Receives mail for posting; Posts various payments and adjustments from insurance companies and patients; Trains new staff members and current employees on new procedures; Attends and participates in office meetings to review problems and issues and to review, identify and develop process improvements. FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Thorough knowledge of hospital and professional services billing, terminology and procedures; good knowledge of hospital and professional services, charges, revenue and diagnosis codes; working knowledge of Medicare, Medicaid, governmental and third party payer and patient self-pay billing guidelines, rules and regulations; working knowledge of HIPAA; ability to perform basic arithmetic computations; ability to use computer applications including Word, Excel and billing systems; ability to analyze reports; ability to prepare statements and bills; ability to communicate effectively, both orally and in writing; ability to carry out oral and written instructions; ability to train staff; ability to work both independently and in a team setting; ability to multi-task; accuracy; neatness; tact; courtesy; capable of performing the essential functions of the position with or without reasonable accommodation.