What are the responsibilities and job description for the Billing and Claims Specialist position at Albany Area Primary Health Care?
JOB SUMMARY
The position of Accounts Receivable Billing and Claims Specialist is responsible for maintaining accounts receivable for all payers. This includes timely and accurate billing services provided, collection of accounts receivable, claims submission to payers, follow up on claim, and month-end processing.
Responsibilities and Duties
Responsible for creating, scrubbing, and submitting claims to Medicare, Medicaid, commercial, and all other various companies.
Responsible for creating and scrubbing all self pay claims.
Assist facility managers in working accounts receivable for all payers
Assist facility mangers and collection clerk in working self pay accounts receivable
Follow up with all payers on unpaid or denied claims
Document follow up notes on the claim
Updates patient demographic data or insurance information on EHR system
Assist facility managers and staff with understanding of insurance claims
Stay abreast of changes for all payers
Alert Insurance Manager of payers that are reimbursing at current fee schedule
Stays abreast of participation in managed care contracts negotiated by AAPHC, benefits of plan and patient responsibility.
Process turn a round documents and other functions for follow-up on payment of claims
Corrects insurance information where needed
Reviews accounts and ensures that insurance adjustments are recorded on a timely basis
Generates and works outstanding claims list and aging analysis by payor type
Performs write offs per AAPHC financial policies and brings any account problems to attention of the Insurance Manager
Establishes rapport with insurance companies and other agencies to facilitate appropriate corrections on denied claims
Runs pending report and reports findings to Insurance Manager on weekly basis
Posts insurance payments to accounts
Trend claim denials and utilizes information for provider and employee education
Request refund payments per financial policies
Assist with hospital list and nursing home list as requested
Promotes facility staff development by providing insurance and demographic support and training
Ensures credit balances are worked on a consistent basis
Troubleshoots claims transmissions to ensure claims issues are resolved timely to prevent delay in payment
Communicates with Insurance Manager if codes could cause denial of claim
Update patient information in EHR system, as needed
Performs other duties as assigned
KNOWLEDGE, SKILLS AND ABILITIES
Knowledge of medical business procedures, coding and insurance reimbursement practices, patient accounting systems and computer data entry, organization’s policy and procedures specific to patient billing
Attention to detail and accuracy.
Ability to work with the public and respect for patient confidentiality.
EDUCATION AND EXPERIENCE
Minimum high school graduate; some college preferred
Minimum of one year experience specific to procedure and diagnosis coding with medical terminology and patient billing.
TYPICAL PHYSICAL DEMANDS
Manual dexterity required for use of computer keyboard and calculator. Working in an office environment. Requires sitting for long periods of time.
TYPICAL WORKING CONDITIONS
Work is performed in an office environment. Involves frequent phone contact with insurance representatives. Work may be stressful at times. Interaction with others is constant and interruptive. Contact may involve dealing with angry or upset people. Occasional evening or weekend work.
JOB RELATIONSHIPS
Supervised By: Insurance Manager
Employees Supervised: None
