Billing & Collections Specialist

Description

Business Office –Billing & Collections Specialist

The Business Office employee, under the supervision of the Business Office Director and Business Office Supervisor, is responsible for the financial success of the facility as it relates to revenue cycle management. The employee should have a full understanding of each of the processes to maximize reimbursement: collections of all payer types, billing and revenue coding, insurance benefit interpretation, authorization, admission sources, payer specific requirements, contract reimbursement, claim editing, clearinghouse processing, adjudication, and appeals/denial management.

It is understood that business office clerks will change tasks from time to time to meet the needs of the business.

Projects a professional demeanor and appearance while maintaining the confidentiality of patients, co-workers, and the surgery center and adhering to the HIPAA policy. Reports, in good faith, any known or suspected activity that appears to violate laws, rules, regulations or the SP Code of Conduct. Fulfills annual Competency continuing education requirements. Personal attributes include the ability to be self-directed; demonstrates accountability, professionalism, and receptiveness to change;

seeks guidance, direction, and assistance when needed. Works under stress and in situations that demand patience, stamina, endurance, and tact while providing impeccable service. Fosters an attitude of teamwork and willingness to assist others and does not refuse performing other job duties as requested within the hospital or hospital outpatient department. Set's priorities, responds timely to issues, which require a decision, and ensure desired results are achieved by means of consistent, follow through.

Willingly accepts other assignments as the need arises.

• Assigned tasks to be completed accurately, and within specified timelines.
• Assures Annual competency education is up to date and completed prior to deadlines.
• Participates in regular departmental staff meetings and facility-wide meetings.
• Always on time for work and attendance is within company policy guidelines
• Willingness to assist in orientation of new staff and ensuring a high level of employee satisfaction and retention.
• Performance self-evaluations to be completed and returned before scheduled date for annual performance review.
• Performs and conducts self in a professional and appropriate manner in all situations
• Demonstrates respect and cooperation in all staff relationships, and a genuine willingness to prevent or resolve inter-personal conflicts.
• Demonstrates the ability to participate in and/or implement team decisions.
• Accepts and implements change in a positive and professional manner.

• Ensures accurate, appropriate, and timely billing for facility claims of admission of various admission types, payers, and locations.
• Completes claim audit for correct billing/coding/authorization prior to claim submission
• Completes required claim data fields and edits to ensure clean claim submission
• Complete claim batch processing through database and claims clearinghouse
• Review database edits and claim holds for resolution
• Monitors clearinghouse claims processing daily for claims management
• Monitors payer websites for claims status and billing updates
• Interprets payer contracts to ensure payments received is in line with expected reimbursement
• Capable of adjudication and analysis of claims processing based on payer explanation of benefits
• Performs daily financial review of accounts receivable for reimbursement
• Addresses payer denials timely and submits required appeals
• Processes payer correspondence and appropriately addresses requests
• Communicates with other departments/provider offices as it pertains to resolution of reimbursement for collection
• Completes required billing/collection reports as assigned by management
• Assist with timely month end billing/collection processes
• Addresses payer issues with patients when related to billing & charge issues, coordination of benefits, third-party liability, injury, PIP, denials, non-coverage, etc.
• Makes…