Medical Billing and Collections Specialist (ONSITE)

Job Summary

The Insurance Follow-Up Representative reviews and researches unpaid claims in accordance with contracts and policies in order to achieve maximum reimbursement. The core responsibilities will include: identifying unpaid claims through reports and dashboards; reviewing submitted claims for complete information, correcting and completing claims and/or forms as needed; addressing denial letters and insurance medical records requests needed for claims processing; and resubmitting claims returned to provider/subscriber if additional information in needed. Additional follow-up responsibilities include: direct follow up with patient when required; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general patient phone inquiries including patient payments, then recording the results in the practice management system.

Qualifications:

• High school diploma or an equivalent combination of education and experience.
• Associate degree or higher in coding or health information management, accounting or business administration highly desired.
• Data entry skills (50-60 keystrokes per minute)
• Past work experience of at least one year within a healthcare setting, an insurance company, managed care organization or other financial service setting, performing medical claims processing, patient financial counseling, coding and/or claims follow up is required
• Knowledge of insurance and governmental programs, regulations and billing processes (e.g., CMS, Anthem, UHC, etc), managed care contracts and coordination of benefits is required.
• Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-10, CPT, HCPCS), and basic computer skills are required. 
• Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills are necessary in dealing with internal and external customers.
• Accuracy, attentiveness to detail and time management skills are required. 

Responsibilities:

1. Knows, understands, incorporates, and demonstrates the OSNI Core Mission, Vision, and Values in behaviors, practices, and decisions. 
2. Performs all follow-up functions, including the investigation of underpayments, payment delays resulting from denied, rejected and/or pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner. These functions will be in coordination with the Business Office team.
3. Utilizes available data and resources to make decisions regarding complexity of claim processing and payment propensity, and the appropriateness of transferring account to the Billing Manager:
4. Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions;
5. Proactively follows-up on delayed payments by contacting patients and 3rd party payers, and supplying additional data, as required;
6. May perform financial counseling activities, including but not limited to: discussing balances with patients, setting up payment plans, explaining statements and insurance processing. Counsels patient/guarantor on patient's financial liability, third party payer requirements .
7. Counsels patient/guarantor of payment plan options and establishes appropriate plan;
8. Investigates No Fault and Workers' Compensation cases, retrieving police report and insurance information, as required;
9. Determines and manages proper course of action for optimal reimbursement of healthcare charges
10. Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect; and
11. Updates and refiles claim forms in a timely, accurate manner. 
12. Responds to patient and 3rd party payer inquiries (telephone, fax, mail and web-based patient portal), complaints or issues regarding patient billing and collections, either responding directly or referring the problem to an appropriate resource for resolution.
13. Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management, Managed Care, Ancillary and Nursing staff, as required to clarify billing discrepancies, and obtain demographic, clinical, financial and insurance information. 
14. May prepare special reports as directed by the Manager to document billing and follow-up services (e.g., Number of claims and dollars billed, number of claims edited, number of claims unprocessed, etc.). 
15. May serve as relief support, if the work schedule or workload demands assistance to departmental personnel.
16. May also be chosen to serve as a resource to train new employees.
17. Cross- training in various functions is expected to assist in the smooth delivery of departmental services. 
18. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, as well as OSNI’s Standards of Conduct, and other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
19. Other duties as needed and assigned by Billing Manager, Practice Manager, and/or CEO
     

Physical Requirements:

• Ability to fulfill any office activities normally expected in an office setting, to include, but not limited to: remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Fine hand manipulation (keyboarding)
• Must be able to set and organize own work priorities, and adapt to them as they change frequently.
• Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
• Excellent problem solving skills are essential. 
• Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.