Billing Specialist

Reports to:         Billing Manager

FLSA Status:       Non-exempt

Job Summary:

This position is responsible for submitting claims and following up with Medicare contracts, state Medicaid program, and private insurance companies.  The Billing Specialist is also responsible for collecting, posting, and managing account payments.

Qualifications:

1. Some College preferred, High School Diploma or GED required.

2. One (1) – Three (3) years experience in Medical Billing collection practices required.  Previous experience with Hospice is desirable.
3. Knowledge of Medical Billing accounts receivable program desirable.
4. Knowledge of business office procedures.
5. Knowledge of basic medical coding and third-party operating procedures and practices.
6. Ability to operate a computer and basic office equipment.
7. Skill in answering a telephone in a pleasant and helpful manner.
8. Ability to read, understand, and follow verbal and written instructions.
9. Ability to establish and maintain effective working relationships with patients, employees, and the public.
10. Must be well organized and detail-oriented.

Responsibilities:

1. Verifies eligibility to determine primary, secondary, and tertiary payer if applicable.
2. Reviews and validates monthly pre-billing reports.
3. Reconciles census and Hospice level of care reports with claim data.
4. Updates billing system as needed to maintain integrity of billing data entered.
5. Prepares and submits claims either electronically or by paper.
6. Responds to questions from patients, clerical staff, and payers.
7. Identifies and resolves patient billing complaints.
8. Prepares, reviews, and sends patient statements, if applicable.
9. Prepares, reviews, and sends facility room and board statements, if applicable.
10. Reviews and validates patient care invoices received from outside suppliers.
11. Evaluates patient’s financial status and establishes budget payment plans.
12. Follows and reports status of delinquent accounts.
13. Reviews accounts for possible write off or assignment to collection agency.
14. Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
15. Prepares monthly and year-to-date billing reports.
16. Maintains strictest confidentiality and adheres to all HIPPA guidelines/regulations.
17. Performs other duties as assigned. Responsibilities, skills and working conditions may change as needs evolve.

Work Environment: 

This job is performed in a general office environment.  Position works in front of a computer screen for multiple hours requiring long periods of visual concentration.  Moderate lifting of up to 20 lbs is required.  Occasional overtime may be required and or hours may be shortened as business needs dictate.