Billing Specialist

SUMMARY: Coordinates insurance and billing related activities associated with the care of service provided to the customers of the company.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Enter charges accurately and expeditiously to ensure proper records handling and fast payment responses.
• Initiate private pay collections after insurance cancellation, denial or other issue.
• Obtaining referrals and pre-authorizations as well as eligibility and verification of benefit when required.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Following up on unpaid claims within standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Identifying and billing secondary or tertiary insurances.
• Maintain accuracy of tables as well as inform management with rate changes.
• Check to see if claims remain unpaid and follow up with patients and insurance companies to determine the cause of the delay and to keep the billing cycle on track.
• Look into claims that are denied and research how to modify the claim to ensure it is processed correctly at maximum reimbursement.
• Answer inquiries made by patients, insurance companies, or fellow employees regarding assigned accounts, the billing process or the appeals process. This includes reviewing for accuracy, completeness, and obtaining missing information.
• Maintain complete understanding and knowledge of all reimbursement requirements for assigned payer as well as general knowledge for payers outside of those assigned.
• Communicate policy changes/issues to management so information can be communicated out to other areas of company.
• Liaise between payers/provider representatives when necessary.
• Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the billing team and the organization.
• Serves as troubleshooter for accounts receivable problems and as back-up troubleshooter for complete system.
• Other duties as requested by Management.