Billing Specialist II

Great Lakes Bay Health Centers • Saginaw, MI • 22h ago

MULTI LEVEL JOB SUMMARY

The Billing Specialist I (Entry Level) is responsible for the following tasks including but not limited to submission of timely claims, processing and posting payments, working rejected claims and assisting with billing and payment issues. Researching and working rejections correctly per billing department requirements for immediate resubmission to ensure maximization of revenue collected.

The Billing Specialist II (Senior Level) is expected to accurately process and post payments and rejections and find immediate resolution to billing issues in the department. Acting as a Mentor to the Billing Specialist I and being a team player. The Senior Level will monitor trends and communicate with department on any issues or updates that need to be addressed immediately while ensuring all AR is kept current working with no supervision knowing when and how to handle various situations and the importance of completing them.

The Billing Specialist III (Senior/Certified Level) staff that are certified or have a higher level of education and have additional Assistant/Lead duties assigned are responsible for communicating and performing any duties in that department when needed. This advanced level will work independently and ensure tasks are completed accurately and timely and keep current on changes.

ESSENTIAL JOB DUTIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Ensure all claims are submitted for prompt payment. (20%)

Review, batch, and transmit/print claims/statements as assigned in a timely fashion.

Work any rejected files/claims/statements at time of submission to ensure all claims sent were received at Clearinghouse and sent to insurances/patients

Maintain AR. (20%)

Monitor the assigned AR to ensure maintenance of a days in AR ratio of less than 90 while maintaining a standard gross collection ratio.

Work collaboratively and proactively with insurance companies and patients to resolve issues that will lead to payment.

Communicate to Manager any backlogged AR.

Ensure credit balances are worked within 60 days.

Process Payments and Rejections. (20%)

Process and post Credit Card, EOB and ERA payment files timely and accurately to ensure we balance deposits to postings for every batch.

Coordinates with other billing staff to ensure all payments/deductibles/copays are posted monthly.

Input CAS codes (including Rejection codes), date and COB information at time of posting and approve secondary claim to ensure claims are transmitted to Secondary Insurances the day after posting.

Responsible for resolving rejected claim issues to ensure payment of claim. (20%)

Ensure all rejected claims are worked in timely fashion.

Research rejections which include calling insurances to help understand what needs to be corrected and follow through on resubmission of claim based of insurance requirements.

Communicate with Manager and staff on claim issues.

Assists department maintaining patient accounts and providing customer service. (20%)

Answer telephone calls from patients and insurance carriers, providing complete and accurate information to resolve any claim related issue in effort to collect payment on services rendered.

Initiate payment plans and review patient account in efforts to obtain payment and clean up all visits on the patient account.

Verify all visits that are outstanding or have credit balance are worked correctly and resolved.

Advise patients of balances that are past due, attempt to obtain payment/set up budget plans and coordinate Collection Agency balances as applicable.

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