AR Billing Specialist

KEY DUTIES AND RESPONSIBILITIES

• Responsible for monitoring all claim statuses to ensure that all claims are reimbursed and no claims is denied for timely filing
• Responsible for monitoring and/or adjudicating claims that have denied for coding issues
• Post and balance bulk payments from all payor classes to patient accts within 3 days of receipt with 95% accuracy.
• Post Credit Card transactions within 3 days of receipt with 95% accuracy.
• Post adjustments according to the payment rate at the time of service when required by and all contracted payers and government payers within 3 days of receipt with 95% accuracy.
• Pick up bulk copayments from each clinic weekly, review patient account for accurate posting, and prepare for deposit within 3 days of receipt with 95% accuracy.
• Print and post EOBs for daily EFTs.
• Post and reconcile zero balance EOBs- When insurance companies recoup/pay in bulk and no payment is received.
• Post denial transactions from the EOBs received.
• Run daily reports for posting total and balance with daily deposits.
• Pull copies of backup for the overpayment accounts.
• Work the Negative Balance Report on a bi-weekly basis.
• Review and appeal unpaid and denied claims.
• Work directly with the insurance company, healthcare provider, and patient to get a claims processed and paid.
• Note patient accounts when needed.
• Communicate any patient insurance issues to the Patient Access Manager for follow up.
• Answer patients billing questions.
• Handle collections on unpaid accounts as directed by the AR supervisor.
• Update job knowledge by participating in educational opportunities.
• Other duties as assigned by Billing Management.

POSITION REQUIREMENTS

• Minimum two years of college required
• Three years of Medical coding experience including ICD 9/10 and HCPS coding including
• Three years of Medical Billing and Collection experience required including third-party operating procedures and practices
• Experience working with Electronic Health Records.
• Experience with OIG Healthcare Billing Guidelines and Compliance.
• Experience utilizing payer specific guidelines for billing for reimbursement.
• Experience with all aspects of electronic and paper billing including ANSI codes, clearinghouse functions, payer specific claim formats, UB04 and HCPCS.
• Experience with denial management including understanding the ERA, reviewing medical documentation to determine coding errors and payer specific errors.
• Experience with payer specific resubmission processes
• Microsoft Word, Excel and Outlook required
• Experience with Excel data reporting
• Ability to multi-task effectively under stress, prioritize and meet deadlines with strong attention paid to detail of work produced.

SKILLS & COMPETENCIES

• Ability to accurately determine denial reasons using specific knowledge of ICD1 and HCPC codes
• Ability to effectively determine denial reasons for payer specific denials
• Ability to read an Explanation of Benefit and Electronic Remittance Advice documents
• Ability to work with the clearinghouse with claims submission and statuses
• Ability to utilize payer specific guidelines to receive full reimbursement
• Necessary technical skills to use electronic health record, incident reporting system, email, and other

information systems.

• Knowledge of legal, regulatory, and policy compliance issues as they relate to medical coding, billing and documentation.
• Ability to submit claims with 95% accuracy to receive reimbursement including claims submitted both on the UB04 and the CMS1500.
• Ability to take initiative to follow up and make sure all claims are adjudicated.
• Ability to manage claims and delegate to other staff for adjudication.
• Regular attendance and punctuality as well as the ability to schedule work production to meet timeliness.
• Critical thinking and the ability to use independent judgement to manage and impart confidential information is required.
• Skill in answering a telephone in a pleasant and helpful manner.
• Ability to establish and maintain effective working relationships with patients, employees and the public.
• Ability to communicate, both orally and in writing, in a professional manner when dealing with employees, management, patients and insurance payers.
• Ability to handle multiple tasks and to prioritize their importance.
• Must be well organized and detail-oriented.

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ESSENTIAL PHYSICAL REQUIREMENTS

• Ability to meet attendance Monday Friday 8:30 a.m. – 5:00 p.m.
• Ability to work in a fast paced environment.
• Ability to work on the computer for long periods of time.
• Ability to perform focused work with close attention to detail.
• Ability to operate office equipment, including computers, fax machines and phones.
• Good speaking and listening skills.
• Skilled in data entry.
• Ability to interact with others, both in person and through phone, email and written correspondence.

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Job Type: Full-time

Salary: $37,000.00 /year

Required education:

• Associate

Required experience:

• Medical Billing and Collection: 3 years
• Medical Billing And Coding: 3 years