Description

GENERAL SUMMARY OF DUTIES: The Billing and Collection Specialist is responsible for ensuring accurate billing by ensuring timely submission of claims. They will be monitoring claim status, documenting related account activities, researching denials/rejections, posting adjustments and collections of Medicare, Medicaid, Managed Care, and Commercial insurance payers.

REPORTS TO: Revenue Cycle Manager

RESPONSIBILITIES:
Duties may include but are not limited to:

• Responsible for charge and payment entry with Electronic Health Record
• Coordinates and clarifies with providers when necessary regarding incomplete or lacking information for proper claim adjudication
• Responsible for correcting, completing, and processing claims for all payer codes
• Analyze claims to interpret accurate submission to insurance companies
• Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports
• Process appeals online or via paper submission
• Assist in reconciling deposit and patient collections
• Assist with billing audit related information
• Process refund requests
• Communicate with billing and credentialing coordinator to identify and resolve audit review issues
• Process billing calls and questions from patients and third-party carriers
• Answer/respond to correspondence related to patient accounts.
• Answer billing and charge related inquiries by patients, staffs, Managed Care Organization, etc.
• Communicate daily with internal and external customers via phone calls and written communications
• Identify trends and carrier issues relating to billing and reimbursements, reporting findings to RCM Supervisor or Manager
• Research, record findings, and communicates effectively with RCM Supervisor or Manager to achieve optimum performance
• Pursue and participate in education to remain current with changes in the Healthcare industry
• Abides by and promotes HIPAA compliance; maintains strictest confidentiality of patient information
• Contribute to team effort by accomplishing related results as needed
• Promote effective working relations and works effectively as part of a team to facilitate the departments ability to meet its goals and objectives
• Perform other duties as assigned to support UDs Mission, Vision, and Values.

REQUIRED EDUCATION, SKILLS & EXPERIENCE:
High School Diploma or GED required; 3-4 years of coding and/or medical billing experience required; knowledge base and ability to respond accurately to claim questions and denials required. Must have experience with Medicare, Medicaid eligibility requirements, and Managed Care & Commercial insurance payer payment methods. Advanced knowledge in E&M and procedural coding preferred; specialty clinical experience in Gastroenterology preferred. Must be able to operate EMR software, preferably eCW and be proficient in multiple Microsoft Office applications.

ADDITIONAL SKILLS AND EXPERIENCE:
Billing and Collections Specialist must have or be able to:

• Possesses critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as Managed Care & Commercial insurance payer payment methods to understand contractual adjustments on payer contracts or government regulations
• Demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims
• Provide a high level of quality patient care and customer service at all times
• Plan, prioritize, and complete multiple tasks as delegated by RCM Leadership
• Productivity based assignments to be completed within time frame assigned
• Ability to work under pressure; assess, respond, and communicate issues in a timely manner
• Maintain composure and set a professional example to patients and coworkers
• Communicate clearly with patients and coworkers through the telephone, email, and in-person
• Interpret and apply clinical and non-clinical policies and procedures

PHYSICAL/MENTAL/ENVIRONMENTAL DEMANDS
Requires sitting and standing associated with a normal office environment. Travel required as business needs dictate.

DRUG FREE WORKPLACE
United Digestive is a drug free workplace. All offers of employment are contingent upon passing a pre-employment drug screening.

EQUAL OPPORTUNITY EMPLOYER
United Digestive is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, gender, color or national origin in its employment practices.

Qualifications