Billing and Collections Specialist

Job Overview:

The Medical Billing and Collection Specialist is responsible for ensuring accurate billing and timely submission of electronic and paper claims for Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. This role involves monitoring claim status, researching and resolving rejections and denials, documenting account activities, posting adjustments, and managing collections. The Specialist must demonstrate strong critical thinking skills and possess a deep understanding of payer-specific eligibility requirements and payment methods. Proficiency in billing systems is essential for efficient claim processing.

Key Responsibilities:

• Billing & Claim Submission:
• • Responsible for charge and payment entry within the Electronic Health Record (EHR) system.
  • Ensure all claims are corrected, completed, and processed for various payer codes.
  • Analyze and ensure accurate claims submission to insurance companies.
• Follow-up & Collections:
• • Perform follow-up with Medicare, Medicaid, Medicaid Managed Care, and commercial insurers on unpaid accounts identified in aging reports.
  • Process appeals both online and via paper submissions as necessary.
  • Assist with patient collections and reconciliation of deposits.
• Account Management & Adjustments:
• • Process refund requests and post adjustments based on payer contracts and government regulations.
  • Maintain accurate documentation of account activities, rejections, and denials.
  • Assist in providing audit-related information as required.
• Patient & Communication Provider:
• • Address billing-related calls and inquiries from patients and third-party carriers.
  • Communicate effectively with providers to clarify incomplete or missing claim information.
  • Coordinate with billing and credentialing teams to resolve audit issues.
• Team Collaboration & Reporting:
• • Identify trends and carrier-related issues regarding billing and reimbursement. Report findings to the Team Lead or Supervisor.
  • Attend provider meetings, workshops, and training as necessary to stay current with industry changes.
  • Contribute to team efforts and promote a collaborative work environment to meet departmental goals.
• Compliance & Confidentiality:
• • Protect patient information by ensuring confidentiality and compliance with HIPAA regulations.
  • Participate in community engagement activities and clinic events as needed.

Qualifications:

• Education & Certification:
• • High School Diploma or equivalent required; Associate Degree preferred.
  • Certified Biller and Coder strongly preferred.
• Experience:
• • Minimum of two years of experience in an OTP setting.
  • Previous experience with Electronic Medical Record (EMR) systems, especially Methasoft, is a plus..

Work Environment:

• This role is 80% on site at our outpatient clinic at 444 Broadway Menands.