Billing Specialist

PRIMARY DUTIES Maintain a current knowledge of insurance carrier and/or state program claims filing policies and procedures

Verify patient demographics and financial coverage; update as needed

Research and verify patient and/or insurance company and/or state program refunds/recoupments

Adjust patients accounts to reflect changes in payment responsibility

Verify accuracy of information on paper medical claim forms and mail to selected insurance carriers and/or state programs

Research patient charges not automatically assigned to selected insurance carriers and/or state programs, make corrections and assign manually

Maintain patient accounts; give GHC program discounts and/or other adjustments as needed

Appeal service charges rejected by selected insurance carriers and/or state programs and resubmit amended claim forms

Process claims/vouchers as needed for insurance plans and/or state programs

Obtain pre-certifications, prior-authorizations, or referrals for special provider services as needed

Verify motor vehicle or accident information with patient’s insurance carrier

Maintain work ques with claim errors

Assist insurance carriers and/or state programs to acquire supplemental patient information needed to process claims

Assist patients to understand fees for services and billing processes

Assist patients to make payment arrangements and find financial assistance

Assist outside providers and vendors to obtain physician billing information

Assist employees to understand policies and procedures related to billing matters

Communicate and support training issues with billing staff

Comply with all regulations related to confidentiality of patient information

Maintain and/or create new payor and plans as needed

Able to manage multiple priorities and manage stress appropriately

Communicates appropriately and clearly with a pleasant and professional manner to all Demonstrates excellent judgment in handling situations not covered by written or verbal instructions

Demonstrates a commitment to the mission, core values, and goals of Waco Family Medicine and its healthcare delivery including the ability to deliver exceptional patient focus with quality, compassion, and respect

Maintain certifications and website passwords as applicable OTHER DUTIES Assist in scheduling patient appointments

Process billing statements and balance notification letters to patients

Assist patients to make payments on owed balances

Provide follow-up on patient’s payment arrangements

Assist with daily mail duties

Provide backup support for clerks and other billing staff as needed

Other duties as assigned by supervisor PHYSICAL AND MENTAL REQUIREMENTS:

Visual and auditory accuracy

Shift length – 8 hours

Indoor setting

Continuous use of computer, calculator

Long periods of sitting and walking

Frequent use of telephone

Frequent use of stepladder

Continuous repetitive grasping and manipulation of both hands

Continuous conversational communication

Occasional reaching, standing, squatting, bending, kneeling, twisting and climbing

Occasional carrying, lifting, pushing and pulling of up to 10 Lbs Infrequent use of personal transportation

Working in a frequently noise environment

Continuously working in a tight area Understand/carry out simple/detailed, oral/written instructions

Memorize and retain instructions

Read and interpret detailed specifications.

REPORTS TO:

Director of Billing Services

EDUCATION:

High School Diploma or Equivalent required, College Hours preferred

SKILLS:

Computer literacy, knowledge of ICD-10 CM/CPT coding, medical office billing and collection practices, federal/state/local financial assistance programs, strong interpersonal, oral, and written communication skills, excellent telephone, and customer service skills.
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