Sr. Billing and Collections Specialist

Job Description

THIS IS NOT A REMOTE POSITION!

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.