Description

 Medical Billing Specialist II 

• We pay for 100% of your health insurance premium
• Life and Long-term disability paid for each employee
• 3% given yearly by the company in your 401k
• We offer paid vacation and sick time
• Primary Care Partners strives to maintain a positive work life balance for every individual.

Job Summary:

Position is responsible for patient account management duties. This person should have the ability to make decisions or solve problems by using logic to identify key facts, explore alternatives and propose quality solutions. Position interacts with patients both in-person and via phone and exceptional customer service skills are required. Duties include: entering charges and payments, auditing patient accounts for accuracy, verifying account demographic and billing information to secure payment for services rendered, assisting patients with establishing budget payments, accepting patient payments and processing, working past due accounts for collections, and mailing patient correspondence for billing purposes. The position requires someone who is self-motivated and focused to complete tasks with limited supervision and instruction. The Medical Billing Specialist II must have previous experience in medical insurance billing.

Duties/Responsibilities:

• Accurate guarantor demographic and insurance information
  • Creating accounts for new patients
  • Determining current insurance
  • Verifying patient insurance eligibility via insurance websites or calling patients
  • Adding/Removing insurance from account
  • Updating patient demographics through information collected on the automated patient intake platform (Phreesia)
• Patient customer service for - telephone and in person
  • Taking up to 40 calls per person per day
  • Helping patients understand their statements, deductibles, copays, coinsurances
  • Taking payments over the phone
  • Mailing patient documents
  • Address account issues from patient correspondence or incoming calls
  • Monitor and correct duplicate accounts
  • Split family accounts to individual accounts
  • Request refunds for accounts with a negative balance from supervisor
• Charge Entry
  • Reviewing submitted charges from providers, nursing staff and lab technicians for correct billing for 9 clinics for all insurances including self-pay
  • Researching and auditing charts for missed charges
  • Adding/Removing CPT, ICD10 and modifier codes as appropriate
  • Running validation and verification reports on charges entered
  • Working untracked encounter reports
  • Map appropriate diagnosis to charge
  • Medical Billing Specialist II:

• Review of claims for common errors
• Add appropriate modifiers to services

• Payment and adjustment posting
  • Posting insurance payments and adjustments both electronically and manually with correct remittance advice and remark codes, transferring balances to patient
  • Posting patient payments
  • Posting payments collected at front offices
  • Researching denials and aging
  • Communication with insurance companies on denials, reprocessing claims, eligibility confirmation
  • Submitting corrected claims to insurance companies
  • Reviewing accounts for credits, moving credits to balances on accounts and issuing refunds to patients and insurance companies
  • Reviewing accounts for small, uncollectable balances and making adjustments as necessary
  • Medical Billing Specialist II:

• Importing electronic remittance files

• Processing Patient Statements
  • Submitting Patient statements to clearing house
  • Validating claims
  • Printing claims for paper submission
• Insurance Claim Submission
  • Submitting claims electronically to insurance companies
  • Reviewing failed claims from clearing house for missing coordination of benefits information, incorrect policy identification numbers, etc
  • Reviewing rejected claims from insurance companies, correcting claims and resubmitting claims
  • Medical Billing Specialist II:

• Review of failed claim errors in PM
• Printing claims for paper submission for secondary claims

• Daily Close, Monthly, Yearly & Deposit
  • Balancing payments for billing office
  • Balancing payments from 9 different clinics
  • Submitting check payments electronically to bank
  • Creating deposit for cash payments
  • Running monthly/yearly reports on charges, payments, adjustments, refunds

• Collection Account Management

• Contact patients by phone when accounts are past due
• Process bankruptcy notices
• Process affidavits from collection agency
• Credit counseling arrangements
• Post payments from collection agency
• Maintain past due accounts for warnings, pre-collect, collections and discharge
• Communicate with collections agency regarding paid/completed accounts
• Maintain cash box and keep log
• Process NSF patient checks
• Process post office notifications for change of address
• Process Bank of Colorado loans and buy backs
• Process statement hold report
• Process deceased accounts
• Process payroll deductions for employees and maintain spreadsheet

• Front Office Support

• Handle all internal clinic calls
• Answer any billing or insurance questions from front desk staff at all locations
• Enter in any new insurances
• Verify eligibility for new insurances
• Training for front desk staff in adding/updating/removing insurance
• Manage tasks sent from front desk for self-pay patients when charges are not ready at the time of check out
• Call patient to collect self-pay charges when charges have been entered

Work Experience:

Must have at least 5 years of experience in healthcare billing, with experience in charge entry, payment processing, denials, customer service, and collections required.

Education Requirements:

High School Diploma required; Associates Degree in an appropriate healthcare or business related field or certification related to medical billing preferred. Additional directly related experience can be substituted for education.

General Requirements: Experience in Microsoft Office, including Word and Excel, excellent written and verbal communications, ability to manage multiple tasks to prioritize needs, strong attention to detail, strong interpersonal skills with a focus on customer service, personable and positive demeanor, especially when dealing with customers and patients, ability to work independently with minimal supervision, ability to establish and maintain effective working relationships with peers, providers, management staff and contacts inside and outside of the organization, excellent follow up, problem solving and organizational skills.

Position Type/Expected Hours of Work:

This is a full-time position at 40 hours a week. Works primarily Monday through Friday between 8:00 a.m. – 5:00 p.m. Expected hours of work may change at any time with or without notice.

Risk Level:

Low exposure

Working Environment:

This job operates in a professional office environment primarily seated at a desk in a well-lighted, ventilated area.

Physical Demands:

The physical demands descripted here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk and hear. This is primarily a sitting role with significant phone work, some walking around the office with some light lifting. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.

Qualifications

Work Experience:

Must have at least 5 years of experience in healthcare billing, with experience in charge entry, payment processing, denials, customer service, and collections required.

Education Requirements:

High School Diploma required; Associates Degree in an appropriate healthcare or business related field or certification related to medical billing preferred. Additional directly related experience can be substituted for education.

General Requirements: Experience in Microsoft Office, including Word and Excel, excellent written and verbal communications, ability to manage multiple tasks to prioritize needs, strong attention to detail, strong interpersonal skills with a focus on customer service, personable and positive demeanor, especially when dealing with customers and patients, ability to work independently with minimal supervision, ability to establish and maintain effective working relationships with peers, providers, management staff and contacts inside and outside of the organization, excellent follow up, problem solving and organizational skills.