Billing Specialist

Job Description

SUPERVISOR: Billing Manager

DUTIES INCLUDE, BUT ARE NOT LIMITED TO:
Screen patient calls efficiently ensuring accurate registration, appointment scheduling and follow-up appointment scheduling into database.
Verify if patient is a current or former patient and reschedule with initial treating physician. Upon request, caller may be routed to initial treating physician team to initiate transfer of care.
Transfer caller to Self-Pay Department for patients with account balance prior to scheduling future appointments.
Accurately data enter patient demographic information to include patient name, address, contact information, and insurance information.
Respond to patient’s questions and needs by editing, canceling and re-scheduling appointments as necessary according to Company protocols.
Regularly checks Outlook, Athena, NotifyMD and fax for pending messages and follow up on action items within same business day.
Performs patient reminder calls for future appointment dates and documents accordingly.
Documents call summary in Athena.
Resolves pre-certification, registration and case-related concerns prior to a patient's appointment.
Ensures patients have been cleared for specialty service office visits.
Obtains referrals from primary care physicians.
Verify eligibility and benefits to establish office visit.
Work on daily list for designated physician(s) and follow up with office via fax to determine patient coverage, coordination of benefits, etc.
Do precertification for surgical procedures (call insurance company and/or fax clinical to insurance company precertification department to obtain authorization for procedure).
Respond to phone calls from internal doctor teams, check in/check out staff, or primary care physician offices and respond accordingly.
Relays pertinent messages from hospitals and directs team to reschedule surgical procedures at facility where benefits are accepted.
Assist billing department to obtain retro referrals for services that were rendered (either office visits or surgical procedures). This may include hospital procedures, office visits or outpatient surgical procedures.
Review daily schedules to verify that visits have been through pre-authorization process. Any new additions to the schedule will require coordination of benefits and follow up with the respective department.
Review personal faxes for newly scheduled surgery and conduct insurance verification and obtain proper authorizations.
Establishes acceptable payment arrangements with patients, including outstanding balances for all services rendered by the group.
Prepares financial agreement, obtaining patient’s signature, and scan’s into patient electronic medical record.
For verbal financial agreements, Financial Counselor will prepare written agreement and retain until patient’s next scheduled visit to administer.
Note in appointment record for Reception Specialist(s) to contact you upon patient’s arrival in order to administer the Financial Agreement; once signature is obtained – scan in to patient electronic medical record.
Create payment plan in Athena for all secured repayment agreements (documenting the detail financial agreement terms).
Covers patient account collections efforts in co-worker’s absence.
Maintains a positive working relationship with physician staff, reception specialists, insurance companies, funding program representatives, and other financial counselors.
Utilizes resources efficiently and effectively.
Maintains professional composure while performing direct patient collections efforts.
Performs other duties as assigned by Supervisor.
Oversees staff “real time” charge entry to ensure proper coding; make adjustments as required.
Monitors the “hold bucket” and assists physician designee with the clearance of claims through correction and/or resubmission.
Assists physician teams/department staff with billing and collections efforts.
Methods may include research of patient records (electronic or hard copy), communication with physician/department team members, communication with cross-coders, review of payer website, and/or review of payer contract.
Obtain authorization and process adjustments resulting in patient or payer overpayment, special discount promotions, etc. as required.
Generate end of month balance reports and send to designated physicians to determine authorization on account balances that should be sent to collections.
Communicate with Managed Care companies acting as a liaison representing the Department for all reimbursement issues and good will communications.
Follow the requests and directions of department Director, and physicians
Other duties as assigned
Verify WC eligibility, schedule appointments and work with referral source

Position Requirements

POSITION REQUIREMENTS:
EDUCATION: Must have a High School Diploma or equivalent.

EXPERIENCE: 1-2 years progressive work experience in a medical setting. Knowledge of medical terminology and heath insurance. Knowledge of Athena practice management system and/or NotifyMD a plus.

SKILLS: Effective interpersonal and communication skills required. Excellent telephone etiquette and customer service skills. Proficient and accurate data entry. Bilingual is a plus.

ABILITIES: Multitasking experience (example: ability to enter data while conducting customers calls). Ability to develop working relationships with internal and external customers.

OTHER: Other duties to be assigned as necessary and may vary at times, as needed by your immediate supervisor or as directed by the company.

PHYSICAL DEMANDS/WORKING CONDITIONS: Requires prolonged sitting and computer use. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopies, telephone, and other equipment. Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate information to patients and team members. Normal but fast-paced work environment.

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