Billing Office Specialist - Breast Health Network

General Description:

The Billing Office Specialist will be responsible for verifying insurance coverage and obtaining authorizations and pre-certifications for all scheduled appointments for new and established patients, while ensuring patient satisfaction and quality.

Essential Responsibilities:

• Provide customer service by answering incoming calls related to inquiries, and providing resolution based on established procedures.This includes, but is not limited to, inquiries from providers and patients regarding billing, eligibility, enrollment, provider network, program benefits, appeals and grievances. Calls may be triaged according to established procedures. Must maintain accurate, detailed, and well documented logs of each call.
• Generate insurance verification and precertification reports as requested.
• Contact insurance companies for patient benefits and precertification requirements.
• Utilize dedicated insurance and billing programs to research and resolve patient billing inquires and to establish up-front payment arrangements. (Passport, Artiva, Onbase and Host)
• Complete financial analysis and collect estimated patient liabilities.
• Provide estimates to patients and/or physicians as requested.
• Assists front office staff with ensuring point-of-service collections are made when applicable.
• Assist patients with payment arrangements and charity applications.
• Work closely with outside agencies in helping patients apply for Medicaid and state aid.
• Enter notes into the collections system for all patient encounters.
• Maintain journal for cash and credit card payments and provide backup cashiering functions as needed.
• Assists in maintaining patient billing files, records and other information.
• Maintains insurance files regarding updates and changes.
• Identifies, analyzes, and resolves work problems.
• Forward problems or concerns to Administrative Services Manager.
• Maintain professional image and implement excellent customer service to customers.
• Ensures that patients are treated courteously and that other visitors are screened and properly directed.
• Works with other staff to ensure efforts are coordinated and high-quality patient care is provided.
• Performs select administrative duties.
• Compiles and condenses statistical data for reports and records.
• Ensures any patient complaints are handled appropriately.
• Ensure all offices are opened and closed according to established procedures.
• Participates in professional development activities.

General Responsibilities:

• Perform other duties as required and assigned.

Minimum Qualifications:

Education: None required.

Experience: 1 or more years of professional work experience required. 2 or more years of experience in medical office and 1 year of collections experience preferred.

OR equivalent combination of experience and education.

License(s)/Certification(s)/Registration(s) Required: None required.

Knowledge, Skills and Abilities:

• Ability to communicate and instill a commitment to exemplary customer service, ensuring customer satisfaction, and member/provider retention.
• Demonstrated prioritization, problem-solving, organizational skills, and detail-oriented mindset.
• Ability to work independently and with limited supervision along with the ability to function effectively in a team environment.
• Ability to function effectively in a fast-paced and changing environment with multiple priorities and objectives.
• Ability to resolve conflicts, while maintaining professionalism, and ensuring exemplary customer service.
• Ability to evaluate processes and procedures for continuous process improvement.
• Ability to adapt to and work effectively in a fast paced and changing environment with multiple priorities.
• Intermediate word processing, spreadsheets and computer software skills. Knowledge and understanding of medical terminology.
• Knowledge of or experience in Medicaid/Medicare programs.
• Knowledge of or experience and understanding of medical terminology.
• Knowledge of organizational policies, procedures, systems and objectives.
• Knowledge of clinic office procedures.
• Ability to use computer systems and applications.
• Familiarity with medical practices terminology.
• Ability to use proper grammar, spelling, punctuation, and sentence structure to answer correspondence and reports.
• Ability to plan, organize, and oversee workflow.
• Ability to operate office equipment.
• Ability to communicate effectively with patients, clinical and administrative staff, and the public.
• Ability to interpret, adapt and apply guidelines, policies, and procedures,
• Ability to react calmly and effectively in emergency situations.