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Biller / Collector

0-2 years
Not Disclosed
10 Nov. 25, 2024
Job Description
Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Summary:
The Patient Financial Services Billing and Collections Specialist is responsible for managing billing and collections for various insurance types, including Medicare, Medicaid, Commercial Insurance, government agencies, and third-party liability claims. This role ensures timely resolution of unpaid balances, facilitates financial arrangements for patients, and handles financial assistance for qualified patients through outside agencies.

Primary Functions:

  • Maintain and audit accounts receivables/credits over 45 days old, documenting notes for productivity.
  • Work on an average of 30 accounts per day (150 accounts per week).
  • Communicate with billing staff to improve primary and secondary claim billing processes.
  • Review insurance EOBs (Explanation of Benefits) for potential processing errors.
  • Respond to denials and correspondence within a two-day timeframe.
  • Ensure accurate allocation of balances between insurance and patients.
  • Assist patients with billing inquiries, both over the phone and in person.
  • Address audits and regulatory inquiries in a timely manner.
  • Research and resolve credit balances for assigned insurances.
  • Educate staff on assigned payers and serve as the representative for specific payers.
  • Collaborate with other departments for prompt billing corrections.
  • Perform other duties as assigned.

Education and Experience:

  • High school diploma or GED required.
  • 1-3 years of data entry, billing, and claims experience in a healthcare setting or billing externship. Education or knowledge may be substituted for experience.
  • Experience in a multispecialty clinic setting preferred.

Preferred Certifications:

  • Billing Certificate from a certified billing school.
  • Coder and/or Billing Certificate may substitute for knowledge of healthcare billing processes.

Knowledge, Skills, and Abilities:

  • Familiarity with computerized practice management systems (Cerner Electronic Health Record System preferred).
  • Ability to learn billing and collection systems in rural health facilities and critical access hospitals.
  • Strong communication skills, with tact and diplomacy when interacting with diverse groups including staff, providers, and insurance companies.
  • Sensitivity to the patient population being served.
  • Strong attention to detail and ability to work independently with minimal supervision.
  • Proficiency in computers and MS Windows software programs.
  • Knowledge of HIPAA compliance and medical/behavioral health billing.
  • Familiarity with UB04, HCFA1500 claim forms (both electronic and paper).
  • Knowledge of Federally Qualified Health Care billing and reimbursement preferred.
  • Understanding of Medicare and Medicaid guidelines.

Additional Qualifications:

  • Bilingual (English/Spanish) preferred.
  • Healthcare experience highly preferred.

Reporting:
Reports to the PFS Director.

Physical Requirements:

  • Ability to sit, stand, or walk for extended periods.
  • Ability to view a computer screen for long durations.
  • Ability to perform repetitive hand and wrist motions for extended periods.

Hybrid Work Status:
This position requires a minimum of three days in-office per week after completing proper training and with the discretion of the Patient Financial Services Director based on independent work capability.