Patient Financial Services/Access/ Billing Specialist

POSITION SUMMARY

Reporting to the Manager of Patient Financial Services, the Patient Financial Services Specialist to ensure all patients have adequate insurance coverage for our diagnostic service and billed CPT code along with properly recording and storing documents on the patient EMR.

ROLES AND RESPONSIBILITIES:

• Performs insurance eligibility and benefits and precisely documenting coverage cost share (Deductible, Out of Pocket, Coinsurance, Copays) in CRM associated fields.
• Manages data entry in the Microsoft Dynamics CRM software and may need to contact the patient to properly explain quoted insurance benefit and patient share of cost.
• Manages daily intake of new prescriptions along with existing patient insurance updates by contacting the insurance company and asking appropriate questions regarding a patient’s insurance benefits.
• Files received documents via fax or mail appropriately to attach to a patient EMR in our Microsoft Dynamic CRM while entering and updating patient, insurance, contract, revenue and/or reimbursement data into designated systems.
• Contact insurance companies via telephone and insurance-based websites.
• Receives and responds timely to internal/external phone calls, correspondence, and inquiries related to patient accounts.
• Supports all aspects of obtaining pre-authorization including communicating and processing information to patients within acceptable time frames.
• Prepares and submits hardcopy appeal packages, including collecting of all necessary materials for proper appeal creation/modification; making payor specific data changes as required for accurate and timely filing.
• Performs all necessary claim review and research to prevent claim delay as required for accurate and timely billing.
• Identifies problem accounts with payors; investigates and corrects errors and follows-up on missing account information.
• Reads, understands and catalogs as needed different Explanations of Benefits in support of patient conversations.
• Keeps supervisor informed of areas of concern and problems identified.
• Refer uninsured or underinsured patients to support programs for financial assistance as appropriate.
• Files and monitors financial assistance plans, working with management, as necessary.
• Acts as liaison between insurance company, patients, and Notal Vision.
• Meets or exceeds established productivity, quality assurance and performance standards.
• Fosters teamwork by communicating effectively and working cooperatively with others. Has respect for and understanding of other disciplines
• Accepts assignments from management and maintain open communication with their manager to resolve quality and production issues.
• Maintains strict confidentiality regarding confidential conversations, documents, and files
• Participates in educational activities and attends monthly staff meetings.
• Adheres to all HIPAA guidelines/regulations.
• Assumes other duties and responsibilities that are related and appropriate to the position and area and as assigned by Management.

ORGANIZATIONAL RELATIONSHIPS

• Reports to Manager, Patient Financial Services.
• Works closely with NVMC departments, management, executives and CRM operations.

EXPERIENCE AND EDUCATION REQUIREMENTS:

· High School diploma or GED required/associates degree required.

· Two (2) years of experience in customer service, medical billing, benefit verification, healthcare or medical office environment required.

· Understanding of payer EOBs/Remits.

· Strong computer skills including Microsoft Word, Excel, and fast and accurate typing skills.

· Experience with ICD-10 and HCPCS, preferred.

TECHNICAL / FUNCTIONAL SKILL AND KNOWLEDGE REQUIREMENTS:

• Excellent customer service and communication skills.
• Strong computer skills required. This includes proficiency in MS products and CRM systems.
• Must demonstrate ability to work independently with minimum supervision in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs.
• Minimum 2 years of experience in a busy medical office setting in a front desk, patient accounts, or billing capacity.
• Prior experience and familiarity with insurance plans and terminology.
• Must be self-motivated, flexible, and dependable.
• Must have strong organizational and time management skills.
• Bilingual, preferred.
• Excellent oral, written and telephone communication.
• Ability to prioritize and manage multiple tasks with efficiency in dealing with multiple facilities.
• Ability to handle a large volume of project receiving and researching claims.

PHYSICAL DEMANDS:

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions.

While performing the essential functions of this position, the employee is required to sit for a large part of the work day; continuously using a computer to document or to access information, as well as speaking with internal and/or external customers on the telephone; consistently use repetitive motions of the neck, shoulders, arms, elbows, hands, wrists and fingers while using a personal computer, electronic mouse, telephone headset, fax machines, computer keyboard, and other automated equipment; use hands and fingers to finger, handle, reach for, or feel papers and materials throughout the work day; commit to memory and repeat upon demand detailed information regarding product(s) and services; read from a computer monitor throughout the work day; close vision, the ability to focus, and color vision are required; disseminate to and solicit from customers and other staff detailed information; concentrate intensely for long periods of time.

Work Remotely

• Hybrid position at present time.

Job Type: Full-time

Pay: From $19.50 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• High school or equivalent (Required)

Experience:

• billing customer service: 2 years (Required)
• Benefits and eligibility: 2 years (Required)

Language:

• Spanish (Preferred)

Work Location: In person

Salary : $20