Billing Specialist

Billing Specialist

The Billing Specialist is responsible for retrieving all billable charges, timely submission of claims, follow-up on unpaid claims, and answering patient questions regarding their statements within the OCHIN Epic System. This position is responsible for all payers, including Medicare, Medicaid, managed care, commercial insurance, workers' compensation, and private pay. The Billing Specialist's role is focused on maximizing revenues and cash flow by completing these tasks promptly and efficiently. Maintain a designated level of collections using payments and complete follow-through for all denied or rejected claims. Follow up and collect all outstanding receivables from payers and patients, and provide excellent customer service to internal and external customers.

Position-Specific Competencies/Essential Functions/Duties& Responsibilities:

• Retrieve all billable charges within 72 hrs.
• Review, resolve, and bill all outstanding statuses promptly.
• Direct contact with patients to resolve all inquiries on their account(s).
• Monitoring patient account activity through queries and statement review.
• Monitor and maintain the AR Aging Report to achieve department goals.
• Independently resolve follow-up issues related to their work assignments.
• Review, revise, re-process, and follow up on all denials and system-rejected claims.
• Process appeals promptly according to the payer contract.
• Process all patients and insurance refunds.
• Ability to run reports with OCHIN Epic.
• Clear and complete documentation of all accounts worked.
• Utilize extra time during decreased workload to assist in other department projects.
• Contribute to the Billing Department team through a positive attitude, respectful interaction, innovative ideas, efficiency, and ethical behavior.
• Participates in educational activities and attends staff meetings
• Maintains strict confidentiality; adheres to all HIPAA and PHI guidelines/regulations.

Required Knowledge, Skills, and Abilities:

• Must have 3+ years of experience working in a physician or hospital collection setting; knowledge of ICD-10, CPT Codes, and HCPC Codes
• Knowledge of insurance carriers (Medicare, Medicaid, managed care, commercial insurance, and workers' compensation) payment regulations, including various reimbursement schemes, co-insurance, deductibles, contractual adjustments, and sliding fee
• Possess a working knowledge of practice management systems (OCHIN Epic) and Microsoft Office
• Working knowledge of HIPAA and PHI regulations and compliance
• Strong interpersonal and communication skills, and can work successfully in a team-oriented environment
• High attention to detail and the ability to multitask
• Hours: may vary based on organizational needs
• Travel: may vary based on organizational needs

Qualifications:

• Minimum Education Level: High School Diploma
• Minimum 3 years of experience in a FQHC, clinic, physician's office, or hospital setting.

* Education: At a minimum, high school graduate or equivalent. College coursework is highly preferred.

* Experience: Minimum 2 years of experience in a medical office setting. Working knowledge of insurance carrier (Medicare, Medicaid, managed care, commercial insurance, and worker's compensation) payment regulations including reimbursement, co-insurance, and deductibles, and contractual adjustments.

* Expertise: Must have 2+ years of revenue cycle experience working in a medical setting; knowledge of ICD-10, CPT Codes and HCPC Codes. Ability to communicate and interact with individuals and families from diverse ethnic, cultural, and socioeconomic backgrounds. Ability to identify and maintain confidential information with integrity. Ability to effectively work independently and as a member of the team. Ability to effectively communicate with individuals as well as with groups. Requires basic computer skills, e.g., Microsoft Office Software. Excellent organizational skills and ability to problem solve. Ability to prioritize tasks and work assignments.

* Language: Strong interpersonal and communications skills to be able to work successfully independently and in team-oriented environments.

* Hours of Work: Must be able to work flexible hours. May vary based on Organizational need.

* Travel: May vary based on Organizational need.