Billing and Collection Specialist

Department: Business Office

Status: Full-Time

Hours: Mon - Fri

JOB SUMMARY:

The PFS Billing and Collection Specialist is responsible for the review, editing, submission of claims, follow up and collection of outstanding balances in compliance with Federal, State, Local and payer regulations.

RESPONSIBILITIES:

To accurately and timely produce and submit insurance claims to payers. Ensure worked claims are released to payer. Monitor rejections or denials from payer and works for resolution. Performs collection efforts to ensure timely and accurate payments are received from payer. Monitor Bill edit report for accounts that need changes or corrections. Process paper claims as needed. Provide financial /payer reports to Director and CFO.

DUTIES AND RESPONSIBILITIES:

• Open biller work-queue in Quadax, filter claims to prepare for editing.
• Open each individual claim to review and perform claims editing.
• Review for regulatory billing requirements from Quadax edits and address before proceeding.
• Review for correct coding of procedures and diagnosis
• Verify charges; comparison between Medhost and Quadax for accuracy
• Monitor for overlap of days for merging requirements.
• Check correct bill types are on the claim.
• Verify dates of service, insurance, patient status and physician information.
• Release/force claim
• File all claims and secondary claims that can be electronically filed.
• File any paper claims or individual payer hard copy requirements.
• Document notes on the account of the claim status
• Review payer rejections in Quadax work-queue and resolve error s and prepare to resubmit to payer.
• Obtain copies of RAs/EOBs from PFS Representative.
• Review the RA for any discrepancies.
• Make corrections.
• File adjustment claim
• Notate
• Patient responsibility
• Denied charges.
• Investigate reason and accuracy.
• Non-covered charges
• Review and confirm accuracy.
• Review contractual adjustment.
• Post correction to contractual if needed.
• Perform adjustment up to $100 if correction needed.
• If >$100 write up adjustment with documentation and submit to Supervisor for approval.
• Work denials from denial management tool; submit appeals as needed.
• Review worklist in Medhost for account alerts from document
• Monitor department reports related to account balances and payments.
• Accounts receivable
• Goal reports
• Dashboards
• Vendor reports
• Communication; Verbal or Written
• Call or receive calls from patients regarding balances, issues with claims, verification or information needed.
• Contact or receive contact from payers regarding claims, follow-up, requests, denials, or records.
• Hospital departments, clinics and other healthcare facilities related to charges, claims or payment issues.
• Coordination of Benefit communication with payers and patients
• Review credit balance report or via collection follow-up
• Valid credits
• Complete refund request for the payer or patient with attached documentation
• Transfer credit to outstanding patient account balances
• Notate actions on patient account.
• Invalid credits
• Make corrections to reconcile the discrepancy.
• Notate actions on patient account.
• Functions as payer administrator for specific payer websites
• User administration
• Login and password
• OTHER DUTIES AND FUNCTIONS AS ASSIGNED OR REQUIRED

REQUIRED SKILLS AND ABILITIES

• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• 2 years hospital/clinic or healthcare billing and/or collection experience
• Must have clear understanding of billing regulations.
• Detail orientated and ability to recognize inaccuracies and critical thinking skills to determine solutions.
• Self-starter with ability to work with minimal supervision.
• Strong analytical and problem-solving skills.
• Ability to prioritize and complete tasks timely.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient with computer/typing skills and 10 key adding by touch.

EDUCATION, EXPERIENCE, CERTIFICATIONS AND LICENSING REQUIREMENTS:

High school diploma or equivalent.

At least two years billing, collections or healthcare related experience required.

Job Type: Full-time

Pay: $15.00 per hour

Expected hours: 40 per week

Work Location: In person

Salary : $15