Billing & Collections Specialist

Essential Duties and Responsibilities:

 Obtain referrals and pre/post-authorizations for ambulance services
 Check eligibility and benefits verification
 Review insurance and facility claims for accuracy and completeness
 Prepare, review, and transmit claims using billing software, clearinghouse, and payer websites
 Following up on unpaid claims within standard billing cycle timeframe
 Reviewing underpaid claims for appropriate escalation steps to ensure appropriate reimbursement for services
 Calling insurance companies regarding any payment discrepancies
 Identifying and billing secondary or tertiary insurance
 Processing incoming mail and taking appropriate follow up actions to resolve accounts
 Researching and appealing denied claims
 Answering all patient or insurance telephone inquiries
 Contacting the patient to escalate issues with the insurance companies
 Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
 Performing other duties as assigned.

Qualifications:

 Proficient with a PC
 Knowledge of Health Insurance Portability and Accountability Act (HIPAA)
 Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes)
 Knowledge of medical terminology
 Knowledge of Medical Billing
 Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and commercial payers
 Customer service skills for interacting with patients regarding medical claims and payments, including
    communicating with patients and family members of diverse ages and backgrounds.
 Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections
 Ability to work independently and with a group
 Working knowledge of MS Word, Excel
 Ability to maintain effective working relationships.
 Thorough knowledge of office practices
 Ability to type at least 35 words per minute.
 Proficiency using 10 key

Education and Experience Requirements:

 High School Diploma or GED
 Minimum of one year revenue cycle management experience or related experience

Physical Requirements:

 Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other
    federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
 Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local
    standards.
 The employee may occasionally be required to lift and/or move up to 20 pounds
 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision,
    depth perception, and the ability to adjust focus.
 Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and
    other physical exertion.
 Must be able to talk, listen and speak clearly on telephone.
 Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a
    motor vehicle.

Travel Time: Negligible

NOTE:  The above statements are intended to describe the general nature and level of work being performed by the
person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills and
physical demands required of personnel so classified.