Summary: The Billing Support Specialist plays a critical role in supporting the revenue cycle operations of the surgery center. This position is responsible for assisting with medical billing processes, resolving billing inquiries, supporting claims management, and ensuring accurate, timely reimbursement from payers while delivering a high level of service to patients and internal stakeholders.
Essential Responsibilities will include the following, and other duties may be assigned.
Billing Duties and Revenue Cycle Duties:
· Assist with preparation, review, and submission of claims to commercial payers, Medicare, and Medicaid.
· Verify accuracy of CPT, HCPCS, and ICD-10 coding prior to claim submission
· Monitor claim status and follow up on unpaid or denied claims
· Support appeals and corrected claims processes as needed
· Ensure adherence to payer-specific billing requirements and contract terms
· Serves as a liaison between the patient and surgery center to ensure smooth communication regarding patient billing
· Identifies cost concerns
· Collaborate across the organization to ensure accurate documentation and billing
· Identify and escalate billing discrepancies or trends that may impact revenue
· Maintain accurate account documentation in billing systems
· Professionally interacts with insurance companies, physician offices, and other external customers
· Punctually maintains billing database and statistical data for administrative and/or payor use
· Generates reports and verifies month-end data
· Works closely with medical assistants and insurance authorization clerks to balance bill payments and ensure statement information is accurate
· Assists in the completion of delinquent medical record reports monthly
· Files initial billing records
Accounts Receivable Duties:
· Accurately enters payments and related adjustments into the computer system
· Verifies and balances payments to proofs and balance slips
· Thoroughly audits explanation of benefits (EOB) for correct payment amount
· Maintains EOB and appropriate billing files following record retention requirements
· Follows up with payers regarding appeals for underpayment or non-contract amounts in a timely fashion
· Proactively runs past due balance reports and follows up with insurance agencies consistent with payable constraints while maintaining payor manuals.
Accounts Payable Duties:
· Uploads invoices to accounting department
Collections Duties:
· Acts as liaison with surgery center Administrator to resolve billing issues
· Proactively answers correspondence from insurance companies and calls for follow-up on denials, incorrect payments, and past-due accounts
· Calls patients regarding account balances as needed
· Provides follow-up for reports on all accounts over 30 days
Patient Services Duties:
· Respond to patient billing inquiries via phone, email, and in person in a professional and empathetic manner
· Explain charges, insurance coverage, and patient financial responsibility clearly
· Assist patients with payment processing, account resolution, and payment plans when applicable
Other Duties:
· Provides support for medical assistants
· Provide data for OLSG, LLC reports weekly and monthly
· Attends 100% of required safety trainings and participates in all applicable center training and development workshops scheduled by the surgery center
[LE1] Competencies: To perform the job successfully, an individual should demonstrate the following:
· Job Knowledge and Technical Skills – Thoroughly understands all aspects of the job; upholds company standards of ethical operations by ensuring compliance with all federal, state, and local regulations; possesses the practical hands-on experience, needs some direction, drives to build a knowledge base and improve professional skills continuously.
· Medical Office Environment – Possesses an understanding of a medical office operation's functionality, patient safety, and patient flow while providing optimal patient care and consideration.
· Productivity and Dependability – Meets schedules, deadlines, and productivity standards; completes tasks on time or notifies the appropriate person with an alternate plan, strives to exceed productivity standards by completing work promptly, prioritizes workloads, attains needed resources, and execute a strategy that optimized results.
· Communication – Speaks clearly and persuasively in all situations, listens without interrupting and seeks clarification, responds well to questions, and writes in an informative and professional manner.
· Customer Service – Manages difficult or emotional customer situations; promptly responds to customer needs; solicits customer feedback to improve service; promptly responds to requests for service and assistance; meets commitments.
· Teamwork – Works effectively with others; balances the team's needs and those of the individual; gives and welcomes feedback.
· Judgment and Problem Solving – Gathers and analyzes information skillfully using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems; identifies and resolves issues promptly; considers relative costs and benefits of potential actions to choose the most appropriate one; uses reason when dealing with emotional topics.
· Professionalism and Interpersonal Skills – Treats others with respect and consideration regardless of their status or position, tactfully approaches others, focuses on solving conflict without blame, maintains confidentiality, accepts responsibility for own actions, follows through on commitments, remains open to others' ideas and tries new things.
· Adaptability – Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation, copes well with frequent changes, delays, or unexpected events.
· Stress Management – Reacts and responds well under pressure; keeps emotions under control; successfully copes with demands from superiors, subordinates, and peers.
· Initiative – Displays the desire to volunteer readily and undertake self-development activities by seeking increased responsibilities, sets and achieves challenging goals while demonstrating persistence in overcoming obstacles, measures self against excellence standards while asking for and offering help when needed.
· Innovation – Displays original thinking and creativity, meets challenges with resourcefulness, generates suggestions for improving work, develops innovative approaches and ideas, presents ideas and information in a manner that gets others' attention
Qualifications: Successful individuals who perform the responsibilities of this position must perform their essential duties satisfactorily. The requirements listed below represent the knowledge, skill, and abilities required. Reasonable accommodations may be made to assist individuals with disabilities in performing the functions required of the position.
· Education:
o Required: High school diploma or general education degree (GED).
· Required Experience:
o 1–3 years of healthcare billing, medical office, or revenue cycle experience
o Working knowledge of medical terminology, CPT/HCPCS, and ICD-10 coding
o Familiarity with insurance verification, EOBs, and claims lifecycle
· Preferred Experience:
o Experience in an ambulatory surgery center (ASC), hospital outpatient department, or surgical practice
o Knowledge of California payer landscape (e.g., Medicare, Medi-Cal, commercial HMOs/PPOs including Kaiser, Blue Shield, etc.)
o Experience with billing software/EHR systems (e.g., NextGen, Athena, Epic, or similar)
o Certified Professional Biller (CPB) or related certification (a plus)
· Certifications:
o NA
· Language Skills: Must possess the ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Writes routine reports and correspondence and speaks effectively before groups of customers or employees of the organization.
· Mathematical Skills: Must have the ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume while applying concepts of basic algebra and geometry.
· Reasoning Ability: Must possess the ability to solve practical problems and deal with various concrete variables in situations where only limited standardization exists while interpreting various instructions furnished in written, oral, diagram, or schedule form.
· Healthcare Business Acumen: Must have the knowledge and be well-versed in the nuances and complexities of the business aspects of healthcare, including Protected Health Information (PHI) procedures and safeguarding other identifiable information regarding patient data.
· Computer Skills: Must have knowledge of Internet software and Microsoft Suite of Products.
[LE1]Deleting as C.A.R.E.S. does not exist in the same way at the surgery center, and is a behavorial expectation, not necessarily a duty.
Pay: $23.00 - $30.00 per hour
Benefits:
- 401(k)
- AD&D insurance
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
