Billing & Collection Specialist

Job Description

POSITION TITLE: AR and Collection Rep Commercial Insurance Managed Care

REPORTS TO: Department Director

DEPARTMENT: Billing & Collections

FLSA STATUS: NON EXEMPT

• Follow-up on all claims from billing through final resolution for commercial insurance and managed care claims.

• Perform necessary correction to errors received from daily electronic billing reports, paper claim submissions and third party confirmation reports. Where applicable, make corrections in the billing system.
• Expedite payment of outstanding accounts through regularly scheduled follow‑up activity.
• Review system‑generated reports to identify accounts requiring research based on guidelines established by department. Determine appropriate action to resolve accounts, securing prompt and accurate payment. Document results in appropriate system(s) and log; alert supervisor and/or manager of non‑payment trends.
• Research partial payments and determine if appropriate contractual allowance was calculated at time of billing based on reimbursement rules. Initiate corrective action for resolution of account, including collaboration with clinical department. Document results in appropriate system(s) or log; alert supervisor and/or manager of trends with miscalculation of contractual allowances.
• Research rejected and/or denied services. Determine corrective action to be taken. Complete corrective action, utilizing departmental procedures and policies, and document results in appropriate system(s) and log; alert supervisor and/or manager of non‑payment trends.
• Complete productivity reports and forward to supervisor per established time frame.
• Support customer service and performance improvement goals of the department; collaborate with other staff, within and outside the department, to develop means of enhancing patient care and service.
• Maintain standards of confidentiality.
• Possess ability to interact with variety of individuals as a problem‑solver and have very good verbal and written communication skills. Strong analytical and organizational skills essential.
• Demonstrate excellent customer service skills when responding to incoming or outgoing calls in a courteous manner, providing clear and appropriate information as needed.
• Exercise good judgment towards account resolution and document all activity on account in a clear, accurate and consistent manner utilizing appropriate system.
• Resolve credit balances in accordance with departmental policy and procedure.
• Maintain, process and log in AR records all requests for MR.
• Know and adhere to all hospital policies and procedures, including attendance management, rules of conduct, HIPAA, dress code, and use of identification.
• Successfully complete previous year's goals or performance improvement plan.
• Perform other duties as assigned.

• Always introduce yourself to customers, patients and visitors professionally and courteously.
• Direct patients and visitors who appear to be lost; contribute positively to morale and demonstrate service excellence by being respectful, empathetic, helpful and attentive; respond promptly to inquiries.
• Always treat all customers, co‑workers with respect and professionalism per HR rules of conduct policy.

• Be 100% compliant with 90‑day and annual performance reviews of staff by due date.
• Participate in performance improvement (PI) projects as set forth by manager.
• Maintain current and valid credentials/license with relevant governing body and stay knowledgeable of all changes in federal, state, local and regulatory body laws, rules and regulations.
• Comply with HIPAA rules, regulations, and current patient safety standards.

• May be exposed to a variety of activities and conditions that place you at risk to exposure to certain diseases and circumstances.
• Able to handle emergency or crisis situations.
• May be exposed to blood‑borne pathogens and bodily fluids.
• May be exposed to a variety of electro‑mechanical hazards and radiation.
• May be required to wear protective equipment as necessary.
• May be exposed to hazards of flammable and/or explosive gases.
• May be exposed to outside elements (accidents, injuries, illness, death).
• May be exposed to varying and unpredictable situations.
• May be occasionally subject to irregular hours.
• May be exposed to stress due to multiple tasks & demands for time.
• Able to walk, stand, sit, lift, push, pull, carry, stoop, kneel and climb without restriction.
• May be exposed to extreme weather changes—hot, cold, and wet.
• May be exposed to dust, vapors, fumes.