Billing and Collections Specialist - FT

The Billing and Collection Specialist is responsible for the accurate and timely processing of medical claims, insurance follow-up, and collections to ensure optimal revenue cycle performance.  This role requires strong knowledge of medical billing procedures, insurance reimbursement processes, and effective communication skills to resolve outstanding balances with payers and patients.  

Job Duties:

• Generate, review, and/or submit new or corrected medical claims or appeals to assigned payors daily, ensuring compliance with commercial and government billing requirements.
• Resolves claim edits and rejections for billing to all payors daily in the claims clearinghouse and/or Medicare DDE to ensure accurate claim submission when assigned.
• Retrieve and reconcile assigned claim audit reports to ensure claim generation, submission and acceptance.
• Analyzes and conducts research on outstanding or denied claims to determine steps needed for claim resolution.
• Works with payors to resolve reimbursement discrepancies, claim rejections and denials
• Submits corrected claims or appeals as needed in the manner that would ensure a greater chance of claim being approved and processed.  Accurately posts any required adjustments.
• Maintains accurate records by documenting detailed notes on patient account in the information system regarding changes to encounter information, changes to billing information, and other actions
• Collaborates with departmental staff regarding billing information, denials, charges, late charges, or any other inquiries as needed.
• Reviews and resolves assigned health plan and patient credit balances
• Maintains knowledge of commercial and governmental health plan regulations and reimbursement policies and procedures
• Completes assigned reports and statistics for SJPH and Governmental and Regulatory Compliance reporting as needed
• Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim
• Escalates any issues or concerns regarding individual insurance companies, including problem accounts when appropriate intervention is required.
• Serves as a back-up for all PFS positions as needed