Client AR and Billing Specialist

Position: Client A/R and Billing Specialist

FLSA Status: Non-exempt

• Supervised By: COO

FUNCTION: The Client A/R and Billing Specialist is a key member of the Revenue Cycle team, responsible for ensuring the timely and accurate collection of outstanding balances, managing patient accounts receivable (A/R), processing claims, and handling billing operations. This role involves direct communication with patients and insurance providers, resolving billing issues, and maintaining compliance with regulatory standards. The Specialist will also manage the escalation of unpaid accounts to a collection agency when necessary, ensuring all efforts align with organizational policies and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Patient Accounts Receivable Management

• Review and monitor A/R reports to track and resolve outstanding balances.
• Contact patients regarding unpaid balances, provide clear explanations of charges, and arrange payment plans when appropriate.
• Manage the escalation process for delinquent accounts, including preparing and submitting accounts to a collection agency while maintaining accurate documentation.
• Investigate and resolve irregularities in patient accounts, ensuring accurate records and financial transparency.

2. Billing and Claims Processing

• Prepare, submit, and follow up on insurance claims to ensure timely and accurate reimbursement.
• Verify appropriate coding and adherence to insurance requirements.
• Investigate and resolve claim rejections, denials, or discrepancies with insurance providers.
• Identify and bill secondary or tertiary insurances when applicable.

3. Collections and Payment Follow-Up

• Proactively contact patients to collect overdue balances in a professional and empathetic manner.
• Monitor payment plan compliance and follow up on missed payments.
• Execute organizational policies for delinquent accounts, coordinating with collection agencies as needed.
• 4. Insurance Verification and Authorization
• Verify patient insurance coverage and benefits prior to appointments or procedures.
• Obtain referrals and pre-authorizations required for therapeutic services.

5. Documentation and Reporting

• Maintain accurate and detailed records of A/R activities, claims processing, and collection efforts in the EHR or practice management system.
• Generate invoices, account statements, and reports on A/R trends, collections performance, and billing metrics for management review.
• Update billing software with rate changes and maintain system accuracy.

6. Compliance and Best Practices

• Stay current with insurance regulations, medical billing practices, and compliance requirements.
• Assist with general fiscal management and analysis to support organizational goals.
• Identify and implement process improvements to enhance billing and A/R efficiency.

7. Problem Solving and Collaboration

• Address and resolve patient and insurance billing issues, escalating complex cases as necessary.
• Collaborate with the Billing Manager and other team members to optimize workflows and ensure seamless operations.

8. Additional Duties

• Perform other responsibilities as assigned to support departmental and organizational objectives.

REQUIRED PROFESSIONAL KNOWLEDGE, SKILLS & ABILITIES

• Functions effectively in response to workflow or ongoing direction by management
• Understands and functions in a customer first service capacity with the ability to connect and build rapport with clients in person or virtually
• Ability to work effectively with people of diverse cultures, ages, and economic backgrounds
• Self-motivated and strong initiative
• Strong problem-solving skills, good judgment, and attention to detail
• Ability to multi-task and work cooperatively with others (both clients and other staff members)
• Maintain positive attitude and contribute to a positive work culture.
• Good attendance and punctuality
• Knowledge of insurance guidelines including HMO, PPO and other payer requirements and systems
• Knowledge of medical terminology likely to be encountered in insurance verification and /or claims
• Familiarity with CPT and ICD-10 Coding

REQUIRED COMMUNICATIONS SKILLS

• Effective communication abilities to interact via phone, email and/or in-person with all stakeholders
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable manner
• A calm manner and patience working with either patients or insurance companies
• Preferred: Bilingual skills in English and Spanish language

REQUIRED TECHNICAL SKILLS

• Competent use of computer systems and basic typing skills
• Demonstrates necessary proficiency with healthcare electronic clinical systems, including EHR and scheduling systems in medical office settings
• Proficient in clerical/administrative skills, including Microsoft Office suite and other general office software
• Proficient with typical office equipment: Computer, Copier, telephone, Fax, credit card machine, scanner

REQUIRED LICENSES & CERTIFICATIONS

• Required: Valid state Driver’s License
• Preferred: Automobile insurance and reliable transportation
• Must possess a high school diploma or General Educational Development (GED) certificate
• Required: 6 months of healthcare or related experience
• Preferred: Minimum of 1 - 3 years of experience in a medical office setting, a healthcare or related field
• Preferred: Knowledge of business processes usually obtained from a degree in Business Administration, or Health Care Administration

COMPANY MISSION STATEMENT

The mission of InMindOut is to offer the highest standard of emotional wellness products and services. We believe that change is obtainable and can begin with one step.

VISION: Where life’s daily experiences involve love, presence, peace, and hope.

VALUES: Get comfortable being uncomfortable, Create Movement, Find Acceptance and Gratitude, Integrity in our Intentions, Growth Mindset, Take Ownership, Do the next right thing, Service Excellence, Self-Care