Working title: Medical billing and collection specialist
Approved by: Chief Financial officer
Created Date: 02/29/2024
Revised Date:
Salary Range: $18.75-$25.60
EXEMPTION STATUS: Hourly, non-exempt
SCHEDULE: Full Time, 40 hours a week, onsite or hybrid
BENEFITS: Medical, Dental, Vision, Paid Time Off, Paid Sick Leave, Holidays, 403(b) Retirement Program, Life Insurance Plans, Worker Compensation, and Voluntary Benefits.
Position Summary
The medical billing and collection specialist is responsible for ensuring accurate billing, timely submission of electronic and or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustment and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and collection specialist must posses critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments base on payer contracts or government regulations. In addition, the medical billing and collection specialist must demonstrate proficiency with billing systems to ensure all functionality is utilized for upmost efficient processing of claims.
MINIMUM education requirements

• High School Diploma or GED, required.
• Associate degree, preferred.
• Certified Biller and Coder strongly preferred.

MINIMUM work experience requirements

• 2 year's experience with medical billing/collections, preferred.
• Minimum of two years of related experience in a business, medical or technical environment, required.
• Previous experience in a medical office setting and/or experience with an Electronic Medical Records, required

License/certifications

• Billing and or Coding certification, preferred

OTHER SKILLS

• Bilingual, preferred.
• Customer service driven.
• Strong team player
• Understanding of medical terminology and insurance laws/guidelines
• Excellent organization and time management skills along with excellent oral written communication skills
• Ability to learn quickly, build and maintain long term relationships and work with minimal supervision.
• Strong written and verbal communication skills, strong analytical, organizational and time management skills required.

Position duties (essential functions)
Medical Billing and Collection Specialist

• Responsible for charge and payment entry within Electronic Health Record. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/claim adjudication.
• Responsible for correcting, completing, and processing claims for all payer codes.
• Analyze and interpret that claims are accurately sent to insurance companies.
• Analyze and interpret that claims are accurately sent to insurance companies.
• Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports.
• Process appeals online or via paper submission.
• Assist in reconciling deposits and patient collections.
• Assist with billing audit related information.
• Process refund requests.

Communicate with billing and credentialing coordinator to identify and resolve audit review issues.

• Process billing calls and questions from patients and third-party carriers.
• Answer/respond to correspondence related to patient accounts. Is available to answer billing and changes related inquiries by patients, staff, Managed Care Organization, etc.
• Communicate daily with internal and external customers via phone calls and written communications.
• Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Team Lead and/or Supervisor.
• Research, record findings, and communicate effectively with Manager to achieve optimum performance.
• Pursue and participate in education to remain current with changes in the Healthcare industry.
• Maintain patient confidence and protect medical office operations by keeping patient information confidential.
• Contribute to team effort by accomplishing related results as needed.
• Promote effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives.
• Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to insure a professional, responsible and courteous environment.
• Attend on-site/off-site community engagement activities and on-site/off-site clinic events as needed.

General

• Exhibit a caring attitude to co-workers and visitors, including working cooperatively with others for a positive work environment and team-building atmosphere.
• Complies with facility attendance policies and procedures; meets attendance requirements of the job.
• Participates in self-growth opportunities/requirements and participates in training opportunities, in-services and meetings per department and facility policy.
• Requests help and/or guidance as necessary in order to safely perform assigned duties.
• Plans and organizes work activity to complete scheduled assignments on time.
• Completes an acceptable work load and accepts additional tasks willingly.
• Takes appropriate 15 minute breaks and 30 minute for lunch, or notifies Department Lead via email when unable to do so.
• Understands and follows the chain of command when dealing with problems and concerns.
• Complies with facility policies and procedures, including fire evacuation and disaster plans.
• Deals with interpersonal conflict in a healthy and positive manner.
• Completes occurrence and all other reports per facility policy.
• Demonstrates knowledge and practice of standard precautions for prevention of the spread of disease.

Competencies and Annual Requirements
AS REQUIRED FOR THE JOB:

• Annual HOSPITAL & JOB SPECIFIC Skills Competencies
• Annual Education
• COMPLIANCE WITH ALL HOSPITAL EMPLOYEE HEATLH REQUIREMENTS INCLUDING INFLUENZA VACCINE AND OTHER VACCINATIONS AS REQUIRED BY POLICY.

LIST OTHER PREFERRED KNOWLEDGE/SKILLS/ABILITIES NOT PREVIOUSLY LISTED AS A REQUIREMENT:
None, although St. Vincent Health reserves the right to amend, add, or delete any preferred knowledge, skills, or abilities related to this position in its sole discretion and at any time.
LIST OTHER PREFERRED KNOWLEDGE/SKILLS/ABILITIES NOT PREVIOUSLY LISTED AS A REQUIREMENT:
None, although St. Vincent Health reserves the right to amend, add, or delete any required knowledge, skills, or abilities related to this position in its sole discretion and at any time.
I have reviewed these job requirements and verify that I can perform all the essential functions of this position.
Employee Signature: Printed Name: Date:
St. Vincent Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Vincent Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.