Summary

Under the direct supervision of the Director of Outpatient Therapy, the Billing/Collections Specialist is responsible for a broad range of billing processes related to managing the unbilled revenue. Processes claims electronically in addition to hard copy as required by insurance carrier. Works to resolve all billing edits and communicates issues to appropriate department personnel in a timely manner. Reviews late charges and submits adjustments as required. Communicates and works closely with the Business Manager of APN for all patient accounting and financial concerns regarding therapy billing in all therapy offices.

Essential Duties and Responsibilities

Billing

Verifies patient billing information is correct prior to every claim submission.
Works to resolve all identified insurance requirement edits through the electronic billing system; ensures submitted claims meet payer's guidelines.
Balances daily receipts list to cash, checks, and credit card payments received at the end of each day.
Communicates issues to Director of Outpatient Therapy and Business Manager regarding problems with patient access and facility departments.
Monitors daily transmissions of all electronic claims to the clearing house and submits claims monthly.
Works on electronic insurance rejects in order to retransmit with correct insurance information.
Works on rebill request from collection team.
Verifies that all electronic acknowledgements were received by the insurance carriers.
Submits required paper billing to insurance carriers with required documentation, including secondary claims.
Attaches I-bills to paper billing when required.
Reviews late charges based on specific insurance payer requirements. Submits adjustments as required.
Enters notes in the patient accounting system on action taken.
Adheres to state and federal billing guidelines and applies regulations in day-to-day billing practice.
Adheres to HIPAA and PHI guidelines.
Assists with all aspects of the Therapy Office including, registration, billing, collections, and cash posting.
Assists with AR reviews on a weekly basis to identify problems/issues specific to payers and offer direction and resolution avenues to resolve reasons for non-payment or payment delays.
Works with Patient Access Reps for all Therapy Offices ensuring that all patients with third party insurance coverage are verified, notified of any insurance limits, required deductibles, co-insurance amounts and their overall patient responsibility and monitors this is being done correctly.
Interacts with HIM department as needed to ensure coding is completed timely.
Notifies Director of Outpatient Therapy and/or Business Manager of any patient complaints in a timely manner.
Assists with other duties as assigned by the Director of Outpatient Therapy or Business Manager.

Insurance Denials

Assist with working insurance denials and refiles denied claims as necessary.

Answering phones

Courteous to visitors, patients, and physicians' offices
Responsible for discussing patient accounts/bills over the telephone if a patient calls regarding their statements.

Core Competencies

Action Orientation - Targets and achieves results, overcomes obstacles, accepts responsibility, establishes standards and responsibilities, creates a results-oriented environment, and follows through on actions.
Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.
Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo, takes risks, and encourages innovation.
Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.
Customer Orientation - Listens to customers, builds customer confidence, increases customer satisfaction, ensures commitments are met, sets appropriate customer expectations, and responds to customer needs.
Interpersonal Skills - Effectively and productively engages with others and establishes trust, credibility, and confidence with others.
Leadership - Motivates, empowers, inspires, collaborates with, and encourages others. Builds consensus when appropriate. Focuses team members on common goals.
Teamwork - Knows when and how to attract, develop, reward, and utilize teams to optimize results. Acts to build trust, inspire enthusiasm, encourage others, and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

Meets dress code standards and adheres to policies.
Completes annual education requirements.
Maintains regulatory requirements.
Maintains patient confidentiality at all times.
Reports to work on time and as scheduled, completes work within designated time.
Wears identification while on duty, uses computerized punch time system correctly.
Completes in-services and returns in a timely fashion.
Attends annual review and department in-services, as scheduled.
Attends staff meetings or reads and returns all monthly staff meeting minutes.
Represents the organization in a positive and professional manner.
Actively participates in performance improvement and continuous quality improvement (CQI) activities.
Complies with all organizational policies regarding ethical business practices.
Communicates the mission, ethics and goals of the hospital, as well as the focus statement of the department.
Assists other staff members in performing any duty that enhances the delivery of patient care.

Regulatory Requirements

High school diploma.
Medical Billing and Coding Degree
Two (2) or more years' experience with Medical Coding and Billing required.
Preferred Two (2) or more years' experience with Inpatient and Outpatient Therapy Billing

Skills

Ability to communicate effectively in English, both verbally and in writing.
Basic computer knowledge.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires repetitive motions, standing, walking, bending, kneeling and stooping all day. The employee must frequently lift or move items weighing up to 20 pounds.

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