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Billing Specialist

Department: Finance
Location: NW Canton, OH

The Billing Specialist performs accurate submission of claims to various third party commercial insurances, Medicare and/or Medicaid. Responsible for preparation of claims, payment posting for both self-pay and insured patients, accounts receivable, answering phones and providing assistance to both internal and external customers. Knowledge of explanation of benefits, electronic remittance advice and insurance terminology required. ICD-10 coding experience preferred but not required. Applicant must have excellent inter-personal and communication skills.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES – job responsibilities include but are not limited to the following.  Other duties may be assigned as necessary.

 

  • Comply with all with agency protocols, policies and procedures, including any state and federal laws and regulations. 

 

  • Secure sufficient coverage information to confirm with insurer dates of eligibility and outline of benefits and assists with patient requests relative to claim status, balance queries and benefits administration.

 

  • Prepares all government billing forms and invoices including Medicaid, Medicare and any other third party government funding for medical services.  Manages all files and submissions in a timely fashion.  Ensures rebilling as necessary.

 

  • Conduct pre-submission audits to ensure accuracy and completeness of claim coding, pricing, and coverage verification.  Assist with code and error resolution.

 

  • Conducts post-receipt audits of explanation of benefits to ensure claims were processed correctly and patient benefits were administered accurately.  Assist with code and error resolution.  Perform all necessary follow-ups.

 

  • Maintain a positive attitude and excellent customer services skills.

 

  • Helps to establish and maintain billing policies and documentation. 

 

  • Establishes coverage and submits all third party insurance billings for reimbursement of services.

 

  • Monitors and researches outstanding patient and insurance billings by investigating nonpayment and denials.

 

  • Submits statistical and reconciliation reports to the Director of Revenue Cycle, as requested.

 

  • Provide support and assist in training as needed.  Identify inaccurate coding practices and report to the Director of Revenue Cycle.

 

SUPERVISORY RESPONSIBILITIES

None

 

QUALIFICATIONS

To perform this job successfully an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

EDUCATION and/or EXPERIENCE

LEVEL ONE:  High school or GED required.  Minimum 3 years of medical billing & customer service experience.  Position requires an advanced knowledge of public and private insurance billing, excellent computer skills and accuracy.

 

LANGUAGE SKILLS

Level Two:  Spanish speaking candidate preferred.  Strong spoken and written communication skills.  Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.

 

MATHEMATICAL SKILLS

LEVEL TWO:  Ability to work with mathematical concepts such as probability and statistical inference.  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations

 

REASONING ABILITY

LEVEL TWO: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

 

CERTIFICATES, LICENSES, REGISTRATIONS

Valid Driver’s License

 

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel.  The employee frequently is required to reach with hands and arms.  The employee is occasionally required to stand, walk, talk and hear.  Specific vision abilities required by this job include close vision, and ability to adjust focus.

 

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Most of the work will be performed in an indoor climate controlled work environment. 

 

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with this job.  While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed when circumstances change.

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