Senior Billing and Collections Specialist

Job Summary: 

 The senior billing and collection specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicaid, Medicare, Managed Care, and commercial insurance payers.  

Major Duties & Responsibilities:

•     Responsible for charge and payment entry within Electronic Health Record.  Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/claim adjudication.

•    Responsible for correcting, completing, and processing claims for all payer codes.

•    Analyze and interpret that claims are accurately sent to insurance companies. 

•    Perform follow-up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance payers on unpaid insurance accounts identified through aging reports.

•    Assist in reconciling deposit and patient collections.

•    Process refund requests.

•    Attend provider meetings when needed.

•    Attend payer trainings and/or workshops when needed.

•    Communicate and/or escalate billing/collections issues to the Revenue Cycle Director or designee. 

•    Respond to billing calls and questions from patients, insurance payers other and third-party carriers.

•    Communicate daily with internal and external customers via phone calls and written communication.

•    Identify trends, and payer issues related to billing and reimbursements.  Report findings to Revenue Cycle Director or designee.

•    Follow through with customer inquiries, requests, and complaints.  Escalate and forward difficult and non-routine inquiries, requests or complaints to the Revenue Cycle Director or designee.

•    Research, record findings, and communicates effectively with Revenue Cycle Director or designee to achieve optimum performance.

•    Contribute to team effort by accomplishing related individual and team metrics as needed.

•    Promote effective working relations and work effectively as part of a team to facilitate the department’s ability to meet its goals and objectives.

•    Demonstrate respect and regard for the dignity of all patients, families, visitors, insurance payer representatives, and fellow employees to insure a professional, responsible, and courteous environment.

•    Analyze progress notes and documentation sent by providers for validation following CMS guidelines ICD-10 and CPT coding.

•    Evaluate documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures.

•    Partner with the Revenue Cycle Director or designee to consistently educate providers, leadership team, and other stakeholders and/or employees to ensure improvement in coding accuracy, as necessary.

•    Perform other duties as assigned to support OHCC’s Mission, Vision, and Values.

Minimum Education/ Experience Qualifications:

•    Minimum of three consecutive years of related experience in a business, medical or technical environment required.

•    2 years of revenue cycle management experience required.

•    Associates Degree highly preferred.

•    Previous experience in a medical office, FQHC, hospital or other outpatient facility preferred

•    Experience with an Electronic Health Record a plus, Athena experience preferred.

Skill, Licensure and Knowledge Requirements

•    Understanding of medical terminology and insurance laws/guidelines.

•    Understanding of Medicare, Medicaid, Managed Care, and Commercial Insurance highly preferred.

•    CPC, CPM, or other revenue cycle related credential(s) a plus, however not required.

•    Excellent follow-up and follow-through skills.

•    Natural customer centric attitude with the ability to build positive long-lasting relationships with clients and team members.

•    Excellent oral and written communication and interpersonal skills.

•    Self-motivated with strong organizational, multi-tasking, planning, and follow up skills with a high level of ownership and accountability.

Physical Demands:

•    Work is normally performed in an administrative office and/or typical health clinic work environment while handling a multitude of tasks simultaneously and communicates with staff in verbal and written form.