Billing Specialist

Job Summary

The Billing Specialist answers patient inquires and handles correspondence and questionnaires from patients and contacts them when needed. This position demonstrates sound working knowledge of government regulations and other insurers requirements. The specialist identifies claims which cannot be transmitted, obtains and keys information which is a prerequisite to claim filing, and establishes a daily routine from the work queue to track pending eligibilities and unpaid claims. The Billing Specialist assists Manger/Supervisor in defining new requirements, inefficiencies and errors.
Essential Job Functions

• Answers patient inquiries, both clinic and hospital accounts, and obtains Medicare secondary payer information. Handles all correspondence and questionnaires from patients.

• Obtains and keys information which is a prerequisite to claim filing, makes any needed edit changes to the primary payer designation and completes these procedures prior to the release of any applicable holds. Reviews appropriate accounts to be placed on hold.

• Performs billing that optimizes cash returns and minimizes denied charges, follows guidelines in a sensitive, yet assertive manner when assisting patients.

• Identifies claims which cannot be transmitted and requests paper claims from the system and edits, corrects and batches forms for mailing and/or electronic transmissions.

• Works coverage update work queues or retro adjudication work queues appropriately on a daily basis. Works daily work queue of accounts on hold and completes combined accounts, provider based and inpatient hospital claims.

• Assists Manager/Supervisor in defining new requirements, suggesting solutions and testing additional systems or enhancements.

• Responds appropriately to necessary changes by staying up-to-date on payer requirements and system capabilities through insurance bulletins by working and editing accounts.

• Identifies delays, inefficiencies and errors which delay the claims process and solves them independently if possible or reports to Manager/Supervisor.

• Performs other duties as assigned or needed to meet the needs of the department/organization.

• Demonstrates understanding and follows infection control policies and procedures according to standard operating procedure.
• Maintains requirements for age specific competencies for the position and demonstrates the knowledge or principles of growth and developments and the skills necessary to provide patient/customer care/services.
• Demonstrates knowledge and understanding of and compliance with:
  • All pertinent safety, health and environmental policies, procedures and guidelines.
  • Working safely, without causing harm or risk to self, others or property.
  • The work environment safety procedures and prompt reporting of unsafe practices, procedures, accidents, injuries or other safety violations to the Leader.
  • The use of all safety equipment and personal protective equipment.

Driving Requirements

• Professional Drivers: Persons who drive as their main responsibility OR transport passengers or hazardous materials.
• Frequent Drivers: Persons whose main responsibility is not driving, but drive daily or almost daily.
• Occasional Drivers: Persons who drive from once per month to as frequently as once per week.
• Infrequent Drivers: Persons who are generally not expected to drive.

Driving Category

Infrequent Driver
Education & Experience
Degree/Diploma

Program of Study

Required/Preferred

Associate's

Business

Required

Or

Associate's

Related Field

Required

Experience

Required/Preferred

Or

A minimum of 2 years of related experience

Required
Knowledge & Skills
Title

Required/Preferred

Demonstrates knowledge of medical terminology.

Preferred

Physical Demands
Frequency 8 Hour Shift 10 Hour Shift 12 Hour Shift Rarely (1-4%) 1-19 min 1-24 min 1-29 min Occasionally (5-33%) 19 min-2.6 hrs 24 min-3.3 hrs 29 min-3.9 hrs Frequently (34-66%) 2.6-5.3 hrs 3.3-6.6 hrs 3.9-7.9 hrs Continuously (67-100%) 5.3-8 hrs 6.6-10 hrs 7.9-12 hrs

Activity

Frequency

Sit

Frequently (34-66%)

Stand

Occasionally (5-33%)

Walk

Occasionally (5-33%)

Stoop/Bend

Occasionally (5-33%)

Reach

Frequently (34-66%)

Climb

Not Applicable

Crawl

Not Applicable

Squat/Crouch/Kneel

Occasionally (5-33%)

Twist

Occasionally (5-33%)

Handle/Finger/Feel

Continuously (>67%)

See

Continuously (>67%)

Hear

Continuously (>67%)
Weight Demands
Activity

Amount

Lift - Floor to Waist Level

Sedentary (
Carry

Sedentary (
Push/Pull

Sedentary (
Slide/Transfer

Not Applicable
Working Conditions
Condition

Frequency

Indoor

Continuously (>67%)

Outdoor

Not Applicable

Extreme Temperature

Not Applicable
Employee Health
Functional Assessment

Hazardous Drug Exposure

Fit Testing Required

Not Applicable

No

No