Billing Specialist

JOB RESPONSIBILITIES (Principal responsibilities or job duties)

• Performs all billing and follow-up functions.
• Ensures accurate and complete charge generation and clean claim submission for both paper and electronic claims on a weekly basis.
• Audits accounts for charge accuracy, duplications and overlapped billing, making any adjustments required.
• Edits claim forms, using instructions for each payer, applying principles of coordination of benefits and ensuring correct diagnoses, procedure codes, etc. are utilized.
• Submits insurance claims, responsible for the maintenance of bill holds and the correction of errors to ensure timely and accurate submission.
• Research claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate team members for follow through to ensure timely claim resolution.
• Applies knowledge of specific payer billing and payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to ensure a clean claim.
• Evaluates accounts, resubmits claims, and performs adjustments, write-offs and or balance reversals, if charges were improperly billed or if payments were incorrect.
• Responds to inquiries, complaints or issues regarding client billing and collections, either directly or by referring the client to an appropriate resource for resolution.
• Manages unbilled, unbalanced visits, and other billing related reports.
• Informs billing manager of any charging trends or claim edit/rejection trends and provides examples. Assists in providing education to other departments to reduce errors.
• Assist with accounting, billing and payroll reconciliations as needed.
• Other responsibilities and tasks as business needs demand.

REQUIRED EXPERIENCE, EDUCATION, SKILLS & ABILITIES

• High school diploma or GED required but associate or bachelor's degree preferred.
• Preferred experience in healthcare revenue cycle billing or account receivable.
• Computer/data entry or Microsoft Excel experience.
• Effective communication skills (both written and verbal), attention to detail, self-directed and a positive attitude are essential.
• Effective problem solving and critical thinking skills.
• Maintains positive work relationships with members of own and other teams.
• Assists in orientation and training of team members.
• Adapts to learning new processes, concepts and skills. - Seeks and responds to regular performance feedback from team leaders and provide upward feedback as needed. - Contributes ideas and actions towards the continuous improvement of revenue cycle processes. - Plans, organize and document work to deliver business results by meeting or exceeding all individual operating metrics and team objectives.