BILLING SPECIALIST

This position may require flexible hours, to include overtime. SPECIFIC PERFORMANCE RESPONSIBILITIESAll functions are essential functions unless otherwise noted.The job functions of this position are not limited to the duties listed below. Ensure all facility and physician accounts are prepared for proper billing and account billing productivity standards are met. Review the daily unbilled report and make corrections when required; ensuring accuracy of clean claim data; including authorizations, admit service, revenue codes, diagnoses, contract rates, and benefit reimbursement method.Prepare and submit timely insurance billings to primary, secondary, and tertiary payers. Monitor electronic billings to ensure acceptance through clearinghouse or intermediary. Work any rejections and forward any unresolved issues to collectors for assistance. Issue adjusted, corrected, and/or rebilled claims to third party payers. Ensure all accounts have correct contractual adjustments posted, either automated or manual, and manual adjustments are noted. Posts adjustments, transfer of responsibility (secondary insurance billing, patient responsibility, or collections), and refunds, as necessary. Respond to correspondence and complete re-bill requests within 72 hours of receipt. Work closely with physicians billing agency and reconciling cash. Notify collector and document account when payments are denied. Denial and insurance follow-up management. Analyze accounts to determine account is netted down based on contract rate.Act as back-up for the Data Processor on an "as needed" basis, posting the daily deposit and reconciling the FCR. PHYSICAL & SENSORY REQUIREMENTS, WORK ENVIRONMENT & CONDITIONS: To perform this job successfully, the employee must be able to perform job duties satisfactorily. The qualification requirements listed below are representative of the knowledge, skill, and/or abilities sought. Language Skills: The employee must be able to present information effectively, orally or in writing, and must respond to questions from patients, referral sources, health care professionals, and the public. The ability to read, analyze, interpret and clearly communicate payer information, is critical. Must be computer literate. Must have the ability to maintain patient accounting information, record statistical data, accurately complete forms, and write/communicate data in accordance with standard policies and procedures. Ability to interpret insurance benefits and relay information to physicians, nurses and patients. Ability to read, write and follow directions. Reasoning Ability: Must have the ability to define problems, collect data, and establish facts. The ability to understand basic accounting principles (i.e., adding, subtracting, debits and credits). The employee should be able to interpret information from a variety of concrete and abstract sources and draw valid conclusions. Ability to establish priorities effectively and to be self-directed and capable of working without direct supervision. Physical Demands: While performing the duties of this job, the employee is regularly required to stand, walk, and sit; reach with hands and arms, use hands to finger, handle or feel objects and operate standard office equipment; and talk or hear in person as well as the ability to talk and hear over a telephone are major components of this position. Regularly required to lift and/or move up to 25 pounds (i.e., laptop computers, program materials, patient charts). Specific vision abilities required by this job include close, color, and peripheral vision and ability to adjust focus (frequent computer work).