Billing Specialist

Position Summary: The Billing Specialist is responsible for understanding all aspects of coding, quality assurance and compliance with Federal Payer documentation guidelines. This role works closely with departmental management and coordinates with Physicians. Posting, clean claim submission to clearing house, denials, appeals, follow-up on claims until payment received.

Reports to: Billing Specialist reports directly to the Billing Manager

Flexibility: While this job description is meant to provide an overview and specific responsibilities of the Billing Specialist, ENTA Management reserves the right to make changes, adjustments, and revisions, as needed, to this document and will coordinate such modifications with ENTA’s Practice Administrator and Physicians. While the normal work week is 40 hours, you may be subject to overtime (not to exceed 50 hours per week).

Summary of Specific Duties:

Billing Accounts Receivable Specialist –

• Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal
• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer contract.
• Review and update patient registration information (demographic and insurance) as needed
• Applies appropriate discounts/courtesies based on department policy
• Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up workflow
• Prints and mails claim forms and statements
• Retrieves supporting documents (medical records, authorizations, etc.) as needed and submits to payers
• Appeals reflected claims and claims with low reimbursement
• Confirm credit balances and gathers necessary documentation for processing refund.
• Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issues causing non-payment of claims
• Monitor invoice activity until problem is resolved
• Process daily mail, edits reports, file or pull EOB batches
• Identifies and informs Manager of issues or problems associated with non-payment of claims
• Contacts payors or patients as appropriate for corrective action to resolve the issues and receive payment of the claims

Billing and Payment Posting Specialist –

• Maintaining and clearing of exceptions in the Encoda Payment Manager dashboard daily.
• Daily review of outstanding checks, calling payers to identify delays and/or processing a replacement check.

• Reviewing and completing the weekly statement reports to ensure any monies are moved to avoid unnecessary statement delivery to patients.
• Research and answers billing and documentation questions or problems, submitted by staff, billing staff, and others to ensure compliance with specific payer regulations.
• Posting of all payments and rejections (manual & electronic) in Prime Suite.
• Processing and Handling of all patient and insurance refunds.
• Maintain and movement of payments from credit to line-item charges, ensuring patient credit balance accuracy.
• Completes daily and month-end closing.
• Updates patient demographics for insurance related issues in order to accurately process claims.
• Investigating and updating any returned patient statements via mail

Billing Charge Entry Coding Specialist-

• Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
• Serves as departmental expert on coding questions.
• Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with polices.
• Research and answers billing and documentation questions or problems, submitted by staff, billing staff, and others to ensure compliance with specific payer regulations.
• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payor or contract.
• Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P Consults, ER Consults, Surgeries, medical records.
• Review and resolve Encoda charge review edits daily.
• Charge Entry
• Maintain and movement of payments from credit to line-item charges, ensuring patient credit balance accuracy.
• Completes daily and month-end closing.
• Retrieve and upload sleep studies and operative notes from BayCare system.

Billing Float –

• This position will cover the duties of the Accounts Receivable Specialist, Payment Posting Specialist and Charge Entry Coding Specialist, as detailed above, as needed.

Working Environment:

• Physical demands:
  • Average percent of time during regular shift devote to:
    • Walking, Squatting, Sitting, Bending, Reaching: 75%
    • Standing: 25%
  • Average lifting requirements:
    • Lifting Requirements: 20-40 lbs.
    • Frequency of Lifting: 0-25% of the time
  • Additional physical demands:
    • Ability to grasp with both hands; pinch with thumb or forefinger; turn with hand/arm; reach for (above shoulder height).
    • Ability to type 60 wpm.
    • Ability to operate multi-line telephone system, computer keyboard and ten-key adding machine.

• Visual, Hearing, and Mental demands: Vision adequate to perform essential functions such as read telephone displays/computer terminals for long periods of time, correctable to 20/20. Hearing is adequate to perform essential functions such as answering the telephone. Mental capacity adequate to perform essential functions such as quickly and accurately entering patient demographics and scanning documents while checking in multiple patients. Tact to deal with unfriendly individuals regarding various situations, and adequately handle stress.

• Working Conditions: This position has an option to work from home after training has been completed. Performance, reliability, and overall fit for the role will be assessed prior to an employee being given permission to work remotely and will continue to be assessed once the employee has gone remote. Required to exhibit a positive attitude and a professional appearance and show detail and accuracy. Required to exhibit quality performance of the essential job functions to help the practice run effectively and efficiently.