[Hiring] Medical Billing & Collection Specialist @USA Health Systems

Role Description

The Medical Billing & Collections Specialist professional responsibility within their scope of practice:

• Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization's values.
• Adheres to hospital policies including confidentiality.
• Requires regular and prompt attendance.
• Works the assigned schedule including overtime and call as required.

The Medical Billing & Collections Specialist department responsibilities:

• Requires minimal supervision to safely perform essential functions.
• Utilizes proper body mechanics when moving equipment/supplies that is necessary to perform essential functions.
• Answers incoming calls/assists walk-ins.
• Fields complaints and disputes to the proper personnel.
• Works encounter interrupts daily.
• Works e-mail daily.
• Reviews and monitors in-house encounters.
• Works incoming correspondences.
• Weekly completes encounters in work queues.
• Sets contact terms on encounters, which meet minimum payment requirements.
• Follows up on delinquent final payment plans.
• Prepares encounters for audits and documents and charges with results of audit.
• Researches self-pay encounters for insurance coverage and forwards information to proper area for encounter update.
• Prepares encounters for recommendation of refund.
• Verifies employment and checks probate court for property and estate claims.
• Reviews discharged patients for correctness of patient and insurance information and necessary forms.
• Recommends encounters for suit or placement with an outside collection agency or attorney.
• Reviews Mobile County Record for court action involving patient encounters.
• Submits encounters for estate filing.
• Maintains a thorough and current knowledge of billing requirements and reimbursement methodology for all assigned coverages.
• Maintains reports and lists as required by management.
• Collects and reconciles encounters for assigned coverage.
• Answers telephone and provides information on patient statements/correspondence with the appropriate follow-up.
• Responds timely and accurately to written billing inquiries from patients and/or insurance companies.
• Makes necessary demographic and insurance additions, deletions, and changes to the system guarantor/patient information.
• Utilizes online systems for follow-up and reconciliation of encounters.
• Works audit reports received from insurance companies.
• Maintains encounter integrity by ensuring that insurance pro-ration, adjustments and transactions are accurate.
• Reconciles encounters from insurance Explanation of Benefits.
• Monitors insurance payments and allowances for proper reimbursement per contract.
• Reconciles credit balances.
• Checks work items and email daily and takes appropriate action.
• Identifies solutions to work related problems and issues.
• Requests medical records as needed and follows up on receipt of same.

The Medical Billing & Collections Specialist communication responsibilities:

• Communicates and uses appropriate customer relations skills with physicians, patients, families and USA personnel in person and via telephone.
• Communicates work-related problems and issues to supervisor or management staff.

The Medical Billing & Collections Specialist documentation responsibilities:

• Maintains accurate and complete records by documenting all follow-up activities with insurance company or patient clearly and concisely on the patient encounter.
• Maintains proper filing of patient and insurance correspondence to include Explanation of Benefits and insurance denials.
• Maintains contact file folder on all patients with established contract terms.

The Medical Billing & Collections Specialist citizenship responsibilities:

• Accepts and completes all duties positively and without conflict.
• Cooperates, helps others and improves the performance of the unit.
• Completes all mandatory unit, educational and hospital requirements.
• Utilizes cost effective practices in performing all aspects of the job.
• Adheres to current Infection Control and Safety Standards.
• Other duties as assigned/required.
• Participates on committees as assigned.
• Participates in Performance Improvement activities through quality measurement or participation of ICARE process as assigned.
• Completes all mandatory department, educational and hospital requirements.
• Adheres to current Infection Control and Safety Standards.
• Regular and prompt attendance.
• Ability to work schedule as defined and overtime as required.
• Related duties as assigned.

Qualifications

• High School Diploma and 1 year medical billing and/or collections experience in a medical office setting. Required
• Hospital billing and claim follow-up experience relating to commercial, UHC and Medicare Advantage plans Preferred
• Comparable combination of education and experience may substitute for the above requirements.