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SUMMARY:

The Billing/Accounts Receivable Specialist is responsible for acquiring information for claim processing, posting payments and insurance denials. Financial counseling of patients, communication with patients, collection, and patient’s payment plans.  Manages the accounts receivable, reviewing and researching past due accounts, follow-up on unpaid claims, re-bill if necessary, and collection calls on unpaid accounts. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Review patient charges for accuracy and completeness and obtain any missing information
2. Knowledge of and compliance with insurance, other payers, and internal guidelines, including Medicare, Medicaid, Worker’s Compensation, BCHC and sliding fee scales
3. Prepares and submits clean claims to insurance companies either electronically or by paper
4. Posting of payments and adjustments for patients and third-party payers
5. Using the computerized billing software as a tool, follow-up on unpaid insurance claims and patient accounts and perform necessary research and functions towards collection
6. Answer patient questions regarding charges, payments and adjustments posted to their account
7. Reviews insurance EOB’s, inquiries, and denials. Follow up, correction or re-submittal, as needed
8. Maintain a filing system for all billing related documents to ensure efficient retrieval
9. Reconcile patient payments posted to bank deposits
10. Review accounts for overpayments and prepare refund requests
11. Reconcile bills from outside parties (lab, x-ray)
12. Maintain a desk manual with procedures and how to guides
13. Maintains a positive working relationship with all staff in all departments
14. Other duties as assigned

EDUCATION and/or EXPERIENCE:

Graduation from high school or the equivalent. Accounting or Bookkeeping education preferred. Two years of appropriate office work experience, including at least six months performing duties similar to most of those specified above.  Experience working with and managing accounts receivable and doing reconciliations. Experience in working with third party insurance including, Medicare and Medicaid.

Substitution:  Satisfactory completion of an appropriate vocational training course of study such as medical office training may be substituted for up to one year of the required two years of office work experience.