Billing Specialist

Billing Specialist Masonicare Corporate Services - Wallingford, CT

Day Shift / 40hrs/wk

** THIS POSITION IS ON-SITE**

Under general supervision from Patient Accounts Management, The Billing Specialist performs a variety of complex operations related to the eligibility, claim preparation, claim submission, suspense resolution, claim follow up and credit balance adjudication/reporting for healthcare services provided to Medicare, Medicaid and Commercial Primary/Secondary beneficiaries. Submits third party claims and resolves billing, payment and collection issues.

• Review reports to identify claims that are eligible for billing to intermediaries, insurance companies, third parties and patients. Processes claims and bills in Electronic Medical Record (EMR) system following established procedures.
• Works with operations to resolve issues that impact claims processing. Brings problems and delinquent responses to the attention of Manager. Processes corrections and generates claims for re-processing.
• Reviews denials and zero pay claims from payor remittance advices, researches issues and prepares claims for resubmission.
• Monitors unpaid claims via accounts receivable aging, initiates timely follow up calls and resubmits claims and/or supporting information to receive payment from payor. Works under the direction of Manager to oversee timely collection.
• Maintains detailed claim history in collections database. Maintains statistical data and records. May prepare regularly scheduled or special reports on claims, suspense, denials, credit balances and payment activity.
• Responds by telephone or correspondence to inquiries from patients, family, intermediaries or payers. Explains benefit coverage to patients, researches problems and corrects errors.
• Identifies and investigates problem delinquencies; follows through with collection policy prior to referral to collection agency, legal action, or write off.
• Meets defined productivity metrics set up by Manager and maintains high-quality standards.
• May assist in preparing documentation for appeals, third party audits, legal inquiries, litigation, and court appearances. Assists in special projects as needed. Performs general clerical duties to support the team.
• Works as a cross-functional team member by providing training to others and furthering training in current systems as appropriate. Assists in documenting step-by-step task processes for each task and maintains a process manual at workstation.
• Follows established departmental policies, procedures and objectives.
• Performs miscellaneous job-related duties as assigned.

• Education:
  
  High School Diploma or GED
• Experience:
  
  1 to 3 years’ experience in healthcare billing.