Job Description

Position Title:

BILLING SPECIALIST

General Description

The Billing Specialist is responsible for providing support to the Revenue Cycle Department. This position manages a very high volume of claims and must work quickly and efficiently to manage the consistent flow of work.

Tasks & Responsibilities

A. Essential Duties

1. Generates insurance claims and collects outstanding insurance balances.
2. Submits appeals and reconsiderations to insurance companies.
3. Makes follow-up calls to the insurance companies on accounts with outstanding balances.
4. Maintains standards to ensure systematic, consistent, and timely collection follow-up.
5. If claims are denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database.
6. Ensure medical records needed for billing purposes are in client’s charts and/or submitted.
7. Completes all payer rejections in a timely manner in accordance with department standards.
8. Identifies, separates, and mails claims that require paper submissions for timely submission.
9. Monitors provider enrollments to assure that claims process correctly to ensure timely reimbursements.
10. Reviews, researches, and amends correspondence/explanation of benefits and makes appropriate adjustments to accounts.
11. Identifies and communicates possible system and reimbursement problems to facilitate an efficient and accurate review of the payers.
12. Meets billing compliance standards.
13. Contact insurance carriers to have claims reprocessed in accordance with contracts and plan benefits.
14. Protects Facility value by keeping collection information confidential.
15. Update job knowledge by participating in continuing education opportunities.
16. Review billing reports identify areas that need attention.
17. Provide supervisor with follow up from billing reports.
18. Bi-weekly supervision.

B. Additional Duties

1. Assists and covers other staff when necessary to maintain high productivity and efficiency in the department.
2. As the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.

C. Interpersonal Relations

1. Create Meaningful Connections: Demonstrates ability to function effectively as a part of team. Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.
2. Take Accountability: Take constructive feedback and prevent discourse among our peers.
3. Live in the Solution: Critically thinking should be the solution when problems arise. Having the ability to accepts constructive criticism well in an open and non-defensive manner.
4. Be Professional: Wear business casual attire (please see dress code policy).

Competencies

1. Adaptability
2. Customer Service
3. Decision Making
4. Dependability
5. Ethics
6. Interpersonal Skills
7. Job Knowledge
8. Conflict Management
9. Organization Skills
10. Productivity
11. Self-Development
12. Teamwork

Performance Standards & Measurement

1. Compliance with essential and incidental duties; compliance with company policies and procedures.
2. Compliance with state and federal laws and regulations applicable to the business.

Equipment, Tools & Machines

• Use of computer, telephone, and other office equipment such as a printer and fax.
• Use of company network and email domain.

Working Conditions

• Air conditioned and well-illuminated office environment and outdoor environment.
• May have several responsibilities at once. Interaction with others is constant and can be interruptive.
• Work may be stressful at times due to high level workflow.
• Availability to work flexible hours including weekends, holidays, and evenings as is required to comply with the purpose of the job and accommodate client needs.
• Participates in educational training, orientations, or compliance programs as needed to maintain competency.
• If you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.

Demands

• Enthusiastic self-starter operating with sustained energy and showing great initiative.
• Comfort working with a diverse base of support, including members, employers, providers, colleagues, community leaders, volunteers, non-profit organizations, vendors, etc.
• Excellent interpersonal and communication skills, including ability to read, write, spell in English legibly and without excessive grammatical or communication errors.
• Talk and hear both by person and by telephone; ability to speak clearly and effectively using proper grammar before patients, employees and business partners, among others.
• Excellent organizational skills.
• Accepts constructive criticism well in an open and non-defensive manner.
• Ability to manage conflicting priorities. Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.
• Ability to function independently and with flexibility.
• Ability to work under pressure, handle multiple tasks and interruptions.
• Occasional lifting of moderately heavy office supplies; ability to lift supplies for community events, trade shows, conferences, and other marketing opportunities applicable to the organization; ability to lift, push or pull up to 25lbs.
• Ability to sit, stand, or walk for extended periods of time.
• Must have strong computer skills to meet Microsoft Office and Electronic Health Record software requirements.

Qualifications

Education:

• High School Diploma or equivalent; Billing and Coding Certification from one of the following national certification exams:

1. American Medical Billing Association - Certified Medical Reimbursement Specialist (CRMS) Board Exam
2. AAPC - Certified Professional Coder's (CPC®,) Certified Outpatient Coder (or CPC-HCOC™) [formerly CPC-H®,] Certified Inpatient Coder (CIC™,) or Certified Professional Medical Auditor (CPMA®) Board Exam
3. American Health Information Management Association - Certified Coding Associate (CCA®,) Certified Coding Specialist (CCS®,) or Certified Coding Specialist Physician-Based (CCS or CCS-P®) Board Exam - The CCS & CCS-P credentials require experience in addition to the education

Experience:

• Billing and Coding: Minimum of 1 year
• CPT and ICD coding
• Computer literate: Microsoft Office (Excel, Word, and PowerPoint) required.

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