Job Description Summary
The Billing Specialist will primarily focus on payor reimbursement, Accounts Receivable, denial management, recognize potential high-risk accounts, and develop techniques to improve collections and streamline processes. Will pursue resolution for all patient issues regarding patient accounts. Review/analyze patient accounts and take the necessary steps to resolve patient/guarantor issues. Assist with escalated/high priority account issues. Provide customer service as needed. The College of Dental Medicine (CDM) MUSC billing team member will manage collection issues with CDM Leadership, resolve issues, apply new information to future collection issues, and make suggestions to enhance our efficiency and effectiveness through process improvement. Act as a point of contact and resource for CDM Faculty, Residents and Staff for coding and accounting questions, assistance with accounts, and policy questions. Provide teaching and guidance for CDM students regarding patient coding, patient estimate and account management and financial treatment plans. Establish and maintain positive working relationships with patients, payers, team members, and clients. Maintain confidentiality of patient information, organization data and information always in compliance with HIPAA regulations.
Entity
Medical University of South Carolina (MUSC - Univ)
Worker Type
Employee
Worker Sub-Type
Classified
Cost Center
CC000058 CDM Dean Finance & Administration
Pay Rate Type
Hourly
Pay Grade
University-GEN08
Pay Range
45,300.00 - 61,100.00 - 77,000.000
Scheduled Weekly Hours
40
Work Shift
Job Description
30% - Billing/Coding:
- Accurately bill BCBS of SC, Medicaid, self-pay/uninsured, accepted federal grant programs, and commercial dental insurance, processing claims in accordance with payer requirements and organization policy
- Regularly audit claims and EHR documentation for accuracy and Federal, State, and facility policy compliance
- Aid member clients filing claims for non-accepted plans in compliance with CDM MUSC policies.
- Post and allocate payments, electronic remits, and paper explanation of benefits (EOBs).
• Submit pre-treatment estimates according to CDM MUSC policy and upon member client request •Provide treatment plan and estimated cost review upon request
- Process fee adjustment request according to CDM MUSC policies
- Escalate requests that do not meet policy adherence to Clinical Affairs for determination
- Correct claim and charge errors; audit for verification which includes but is not limited to audit of coding, payments, and EHR to identify and rectify any missing or incorrect charges.
- Correct transaction entry errors within EHR -(Essential)
30% - Accounts Receivables:
- Provide Efficient and effective account receivable services on behalf of our member clients to maximize reimbursement and support CDM revenue cycle performance
- Assist with the collections of receivables for guarantor and any third-party payers by monitoring accounts receivables, checking claim status and resubmitting claims of overdue accounts, filing corrected claims or appeals and alerting supervisor of seriously overdue accounts and trends.
- Identify and address significantly overdue accounts according to state and facility policies
- Issue correspondence related to balances, including patient account statements
- Thoroughly research and resolve credit balances.
- Process refunds according to CDM MUSC and SC State policies
- Prepare and drop Billing Office deposit
- Perform deposit reconciliation for all of CDM MUSC deposits according to separation of duties.
- Answer phone calls from patient and responsible parties regarding account balances and/or other account related matters.
- Maintain complete and accurate billing and accounts receivable records
- In office consultations for providers and patients - (Essential)
30% - Account Maintenance:
- Perform registration updates in EHR and address Insurance entry and updates accordingly
- Provide real-time insurance verification for all CDM clinics utilizing personal planner and associated web portal access
- Timely and accurate communication with CDM Faculty, Residents, Staff and Students in accordance with department processes
- Provide regular and Ad Hoc reporting to CDM Leadership for missing charges and unapproved charges / documentation; weekly, monthly, & yearly. Audit when needed to identify trends.
- Identify issues, make updates to Insurance background maintenance within EHR, and assist with additional background maintenance tasks as assigned.
- Assists supervisor and administration with escalated patient account issues; works quickly, accurately, and professionally to resolve high priority patient accounts -(Essential)
10% - Additional Responsibilities:
- Act as a point of contact and resource for CDM Faculty, Staff and Students for coding and accounting questions, assistance with accounts, and policy questions.
- Special projects as needed
- Other duties as assigned - (Essential)
Additional Job Description
Minimum Requirements: A high school diploma and three years professional experience in a related area such as accounting, auditing, finance or commercial lending. A bachelor's degree with multiple accounting courses may be substituted for two years of the required work experience. Physical Requirements: (Note: The following descriptions are applicable to this section: Continuous - 6-8 hours per shift; Frequent - 2-6 hours per shift; Infrequent - 0-2 hours per shift) Ability to perform job functions in an upright position. (Frequent) Ability to perform job functions in a seated position. (Frequent) Ability to perform job functions while walking/mobile. (Frequent) Ability to work indoors. (Continuous) Ability to work in confined/cramped spaces. (Infrequent) Ability to bend at the waist. (Infrequent) Ability to squat and perform job functions. (Infrequent) Ability to fully use both hands/arms. (Continuous) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Frequent) Ability to reach in all directions. (Frequent) Possess good finger dexterity. (Continuous) Ability to maintain tactile sensory functions. (Continuous) Ability to lift and carry up to 15 lbs., unassisted. (Infrequent) Ability to lift objects, up to 15 lbs., from floor level to height of 36 inches, unassisted. (Infrequent) Ability to lower objects, up to 15 lbs., from height of 36 inches to floor level, unassisted. (Infrequent) Ability to push/pull objects, up to 15 lbs., unassisted. (Infrequent) Ability to maintain 20/40 vision, corrected. (Continuous) Ability to see and recognize objects close at hand. (Continuous) Ability to see and recognize objects at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to hear and/or understand conversations. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous) Additional New Requirements: Computer literacy.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
