Billing & Collections Specialist

Join our respected medical practice as our Billing & Collections Representative, where your exceptional attention to detail and revenue cycle expertise will ensure our financial health while providing patients with clear financial guidance. We're seeking an experienced professional who can masterfully navigate insurance claims, patient accounts, and collection processes while maintaining the highest standards of accuracy and compliance. If you thrive in a collaborative healthcare environment and take pride in resolving complex billing challenges with both efficiency and empathy, we offer competitive compensation, professional growth, and the satisfaction of being an essential member of our patient-centered team.

Key Responsibilities include the following:

Charge Entry

• Posts missing charges when discovered

Claims Filing

• Reprocesses all paper and electronic claims for assigned carriers when required — verifies completeness of insurance claim information before sending
• Reviews edit reports from clearinghouse daily and resolves issues so claims can be processed
• Follows up on rejected claims the day that the rejected EOB is received

Claims Account Follow-Up

• Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system "notes"
• Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
• Responds to written and telephone inquiries from patients and insurance companies; manages relationships with personnel from assigned carriers
• Meets with Billing Manager regularly to discuss and solve reimbursement and insurance follow up problems
• Calls carriers to appeal payments that do not match contractual agreement; notifies Billing Manager of payors for which this is a consistent problem; works with Billing Manager and physicians to obtain appeal language for denials and/or unacceptable payment
• Processes requests for insurance refunds, and submits to Billing Manager for approval
• Check payors monthly updates on medical policy/guidelines and report to supervisor

Patient Accounts

• Establishes payment plans within approved guidelines—obtains approval from the Billing Manager when necessary
• Resubmits insurance claims on behalf of patients, if necessary
• Recommends to Billing Manager those accounts needing to go to an outside collection agency and sends out collection letters
• Prints and mails itemized statements to those patients who request them, or transmits claims to outside mailing house for processing
• Processes requests for patient refunds, and submits to Billing Manager for approval
• Meets with Billing Manager, as necessary, to discuss and solve collection problems • Assist patients on claims processing if needed

Payment Posting

• Posts adjustments, withholds, as part of this process, and transfers deductibles and coinsurance to patient responsibility; batches them according to protocol
• Alerts Billing Manager when payments do not match contractual amounts; looks for underpayments and silent PPOs
• Submits balanced payment batches to the Billing Manager daily
• May be required to post all mailed-in payments and electronic payments by line item (in absence of Poster)

General

• Ensure all medical information for patient is accurate, updating when necessary
• Check patient eligibility and benefit verification; update account if discrepancies
• Document all actions taken; scan all documents sent out to payors (ex: appeals paperwork)

Shared Duties/Other

• Ensures that all faxes are cleared off the machine (or routed in the system) and distributed throughout the day
• Sorts incoming reports and directs to appropriate person if not addressed properly
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Maintains and respect the confidentiality of patient information in accordance with company policy & procedure, and HIPAA & compliance guidelines
• Attends regular staff meetings and continuing education sessions as requested
• Presents professional image in manner, appearance, motivation and work habits
• Regular attendance is required
• Performs other duties as assigned

Critical Skills & Attributes

• Academic/Technical Qualifications
• HS diploma or GED required

Industry Experience

• Minimum of 18 months experience in a physician group practice billing department
• Familiar with CPT and ICD-10-CM coding for orthopedic, podiatry & pain management surgery procedures
• Good analytical skills and an affinity for detail
• Knowledge of HIPPA & OSHA guidelines
• Working knowledge of medical practice management systems and electronic medical records
• Basic knowledge of computers and medical terminology is mandatory

Communication Skills

• Excellent verbal, written, and interpersonal skills
• Ability to work well with physicians, employees, patients, and others
• A committed and result-driven attitude to work as a high ethical and professional standard
• Unquestionable commitment to confidentiality, quality customer service and professionalism

* Compensation for this role starts at $20 hourly and will increase with relevant skills and experience *

* This is NOT a remote position. It is in-person at our Linden, NJ location *