Job Summary:
The Billing and Collection Specialist, plays a crucial role in managing financial transactions, ensuring accuracy, and maintaining compliance. Responsibilities revolve around ensuring accurate and timely billing for assigned service line, analyzing patient accounts, identifying overpayments, processing refunds, and managing credit balances in accordance with established policies and regulations. This position is responsible for supporting and contributing to the team efforts in the achievement of pre-established accounts receivable performance goals of:
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Net and Gross Days outstanding in Accounts Receivable
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Percent of Accounts receivable aged greater than 90 days
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Cash Collection Goals
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Credit Balances as a Percent to outstanding receivables
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Denials Resolution
The Patient Account Billing and Collection Specialist performs daily activities related to the successful closure of aged accounts receivable
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Claim submission, corrections and RTPs
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Perform Account Status and Follow up
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Resolve Credit Balances
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Respond to and resolve claim payment denials
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Correspondence resolution
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External audit requests related to credit balances
Key Responsibilities:
1. Utilize the Meditech BAR module to review and analyze patient accounts for accurate billing and collections.
2. Resolve account discrepancies, including rejected or denied claims, by investigating and correcting errors.
3. Review and interpret medical documentation, including medical records, superbills, and encounter forms, to ensure accurate coding and billing.
4. Work closely with healthcare providers and coding staff to clarify any documentation discrepancies or coding-related issues.
5. Generate and submit insurance claims electronically or through paper submission, adhering to all relevant billing regulations and guidelines.
6. Monitor claim statuses and follow up with insurance companies to resolve any outstanding claims or issues.
7. Collaborate with internal departments, such as Registration, Coding, and Finance, to ensure accurate and timely billing processes.
8. Stay updated on industry changes, including coding updates, insurance regulations, and reimbursement policies, and implement necessary changes in billing practices.
9. Maintain accurate records of account management and documentation of billing activities, claim submissions, and payment receipts including Meditech notes and canned text, etc. as directed.
10. Utilize appropriate internal/external applications in conjunction with Meditech to review patient accounts to identify overpayments, duplicate payments and other discrepancies leading to inaccurate account balance.
11. Accurately calculate refunds owed to patients, insurance companies, or other third-party payers.
12. Processes refund requests promptly and efficiently while adhering to the internal protocols and regulatory guidelines.
13. Accurately determines balances and adjustments on accounts that have questionable balances and adjusts accordingly.
14. Monitor and manage credit balances on patient accounts, ensuring timely resolution and appropriate adjustments in accordance with internal protocols and requirements.
15. Collaborate with Cashiers, finance, and payers and applicable third-party vendors to resolve complex refund and credit balance issues.
16. Communicate effectively with patients, insurance representatives, and other stakeholders regarding refund status and inquiries.
17. Maintain detailed records of refund transactions, credit balance adjustments, and related correspondence.
18. Generate reports to track refund activity, credit balance trends, and outstanding issues for management review.
19. Uses proper fee schedules, codes and "caps" as necessary for specific third-party payers.
20. Interprets mail requests from payers, determines necessary action and responds in a timely manner.
21. Interacts with insurance companies to resolve problems, questions, and issues with accounts providing any information required by faxing or mailing records as necessary, not limited to appeals, reconsiderations, telephone follow through, as appropriate per payor.
22. Provide support and guidance to other staff as needed.
23. Respond to external audit requests in relation to credit balances. OMIG and OIG are typical sources in accordance with current internal policy and procedures and regulatory guidelines.
24. Identify opportunities to workflows, enhance efficiency, and minimize errors.
25. Propose and implement process improvements in collaboration with cross-functional teams.
26. Other duties as requested by Supervisor.
Education:
High school diploma (required)
Associates degree in healthcare administration, finance, accounting, or related field (preferred)
Experience:
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Strong understanding of medical terminology, insurance billing practices, and reimbursement processes.
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Proficiency in using electronic health record (EHR) systems and healthcare billing software, including Meditech or similar platforms.
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Excellent analytical skills with attention. Previous experience in healthcare billing, revenue cycle management, or accounts receivable preferred.
Professional Skills and Abilities:
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Excellent interpersonal skills with the ability to interact effectively with all levels of employees and clients
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Ability to work in a team-oriented environment
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Excellent written and verbal communication skills
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Knowledge of Health Care industry
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Detail oriented
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Strong organizational skills
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Ability to analyze and problem solve
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Ability to work with accuracy and attention to detail
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Ability to prioritize and handle multiple tasks simultaneously
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Cooperative work attitude toward and with co-employees, management, patients, and outside contacts
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Ability to promote favorable company image with patients, insurance companies, and general public
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Ability to quickly grasp new processes
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Excellent written/verbal communication
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Well organized
