SVA BILLING AND ACCOUNTS RECEIVABLES SPECIALIST

JOB DESCRIPTION

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POSITION: BILLING and ACCOUNTS RECEIVAVABLES SPECIALIST

DEPARTMENT: Central Business Office

REPORTS TO: Assistant Business Office Manager

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JOB SUMMARY: Southern Vitreoretinal Associates (SVA) Billing and Accounts Receivables Specialist, under direction of the Assistant Business Office Manager, primary responsibility will include working outstanding insurance balances for services rendered by SVA, ensuring timely reimbursement. The Billing and Accounts Receivables Specialist is responsible for researching, analyzing all open claims and any unpaid insurance balances, resolving outstanding issues in a timely manner. Individual will also be responsible for assisting with authorizations, payments and patient communications as necessary.

PRIMARY AREAS OF RESPONSIBILITIES: The duties identified below are the essential functions of the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned that align with the summary of this position.

• Extensive A/R work, claim denials, submitting appeals, checking claim statuses, confirming payments match fee schedules, calling insurance companies
• Payment posting to accounts receivable system from all insurance carriers, patients, and funding companies

• Obtaining insurance eligibility and benefits information with all major insurance companies
• Able to explain patients benefits to patients in a clear and professional manner
• Obtain authorizations for office visits and physician administered medications
• Calculate patient amount due and contact patient via telephone
• Review schedules prior to date of service
• Will approve scheduled and same day injections after checking for necessary authorizations and communicate such to clinical staff
• Maintains excellent communication skills and interpersonal skills with physicians, patients, and co-workers
• Working with Patient Assistance Programs to enroll patients and the ability to explain these programs to patients
• ICD -10 / CPT Code knowledge
• Knowledge of how to read and interpret explanation of benefits
• Payment posting to accounts receivable system
• Review next day balances

ACCOUNTABILITIES:

• Facilitates the rapid and successful conversion of patient revenue into cash, minimize debt, improve cash flow and manage overall health of the Clinic’s receivables.
• Meets or exceeds Key Performance Indicators (KPI’s) that are relevant to the work assigned so that SVA achieves best practice measures for Revenue Cycle.

EXPECTATIONS:

• Reinforces and abides by SVA’s core values. Ensures direct reports abide by the same core values
• Ensures high level of customer service, compassionate, patient-centered care to patients.
• Collaborates across the organization to develop, implement, and maintain processes that positively impact the revenue cycle.

• Understands and complies with all laws, rules, regulations, policies, and procedures applicable to the position.
• Utilizes a variety of office technology, to capture and document services provided, ensuring an accurate billing record.
• Excellent written, verbal and presentation skills necessary to facilitate accurate communication with providers and staff, providing a consistent message.

EDUCATION AND EXPERIENCE:

EXPERIENCE:

• High School diploma or equivalent.
• Billing experience, 1 year minimum required
• Accounts Receivable Experience, 6 months minimum required
• Strong understanding of private insurance rules and regulations
• Excellent organizational skills and keen attention to detail
• Computer literacy with medical accounts receivable programs and internet-based websites
• Able to follow directions quickly and efficiently with varying workloads and interruptions.
• Must be able to work well under pressure and deal with coworkers in a courteous and cooperative manner.
• Good communication skills
• Excellent customer service

INTENT AND FUNCTION OF POSITION DESCRIPTIONS

This position description is intended to cover the most significant aspects of the position. There may be additional responsibilities assigned beyond those stated in this position description. The Company reserves the right to modify the role, responsibilities, requirements and position status as compliance regulations or business needs dictate. Position descriptions assist the company in assuring the hiring process is administered fairly and qualified candidates are selected. They are essential to effective performance management and compensation systems. In accordance with the Americans with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the team member or others or which would impose undue hardship on the Company. Position descriptions are not intended as and do not create employment contracts. The Company maintains its status as an at-will employer and employment separations can occur for any reason not prohibited by law.

Employee Acknowledgement

Employee signature below constitutes employee's understanding of the requirements, essential functions, and duties of the position.

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Employee Printed Name

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Employee Signature Date