Billing Specialist I

JOB SUMMARY:

Responsible for audit of medical, dental, behavioral, and hospital insurance claims for accuracy and timely electronic submission of claims through practice management system. Responsible for follow-up on outstanding claims and for maintaining accurate accounts receivable records in the organization’s practice management system.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. 1. Audit medical, dental, behavioral, and hospital insurance claims for accuracy and timely submission of insurance claims electronically through practice management system.
   2. Application of insurance and other payments, and all adjustments required for accurate patient accounts receivable records.
   3. Responsible for monitoring the patient accounts receivable aging reports and using the reports to identify accounts requiring attention.
   4. Responsible for staying current with information needed for accurate claims submission to Medicaid, Medicare, CHIP, commercial and other third party payers.
   5. Responsible for staying current with the rules and regulations for all payers and the updates or changes in state and federal regulations, and notifying the appropriate health care services (HCS) and management staff.
   6. Review insurance accounts and request adjustments and/or refunds, as appropriate.
   7. Appeal and/or resubmit denied or rejected insurance claims.
   8. Inform Supervisor of accounts receivable issues, and the potential effect the issues may have on the organization and reimbursements.
   9. Work with HCS staff to stay informed of patient flow through the clinics and provide feedback to HCS supervisory staff of incomplete or incorrect information and/or changes in the requirements affecting billing and collections.
   10. Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
   11. Perform other duties as assigned by supervisor.
   12. Follow Access Health accounts receivable policies and procedures.