Billing & Collections Specialist I

Description

POSITION PURPOSE:

The primary duties and responsibilities include the ability to follow up with insurance and/or patient balances which include obtaining claim status, researching rejections and denials, and documenting related account activities. Actively reach out to patients to discuss outstanding balances when denied by insurance and collect balances. Communicate with and support other RCM staff, patients, partner practices and insurance companies to maximize reimbursement and ensure rapid account resolution.

Principal Responsibilities And Duties

• Communicate with patients, practice partners and coworkers by answering telephone, emails messages and TEAMs messages to assist with any questions or apprehensions regarding balances, billing, collections and reimbursement.
• Utilizes MY Transworld Health website to send patient accounts to profit recovery and collections. Updates My TSI with additional information regarding patients’ failure to pay remaining balances if patient submits a dispute.
• Send email with statements to update patients on remaining balances and bad debt.
• Maintains a record for practice with all sent statements and emails regarding billing to patients.
• Updates billing systems to reflect status of collection and patient payments.
• Identifies possible issues or concerns that may impede insurance/patient payments and collaborates with manager to construct a resolution for issue.
• Provides a thorough explanation of benefits to patients and properly explains reasoning behind balances and collections.
• Runs aging report weekly, monitors bucket which includes money in insurance claims that still needs to be collected and follows up with insurance to find reasoning behind outstanding, rejected or pending claims. Reviews errors and provides resolution to issues. (Manager may assign report via email)
• Initiates review of patient accounts with credit balances and issues refunds when necessary.
• Ensures insurance pays correctly and issues adjustments following state law and USOSM protocol.
• Create contact notes with reminder dates to ensure claims are follow- up on timely.
• Pulls zero pay and applies insurance adjustment, updating billing category.
• Follows appropriate procedures before moving patients balance to collection agency.
• Processes/or gives to poster any credit cards when taken over the phone.
• Communicates with practice on accounts needing discretionary adjustments posted.
• Must maintain the accuracy rate determined by manager while training and then maintain 96% or better
• Performs additional duties as assigned by manager or director.
  
  

Minimum Qualifications

Basic Knowledge & Competencies:

• Ability to manage multiple priorities with frequent interruptions
• Excellent oral and written communication skills
• Ability to meet deadlines
• Problem-solving skills
• Exceptional human relations skills
• Must be a team player
• Proficient in use of computers and Patient Management Software
• Adding and subtracting math skills
  
  

Previous Experience/Education

• High School diploma, GED or equivalent
• Experience in a medical and /or dental environment a plus
• An equivalent combination of education and experience is acceptable
  
  

Physical Requirements

• While performing the duties of this job, the employee is regularly required to sit for prolonged periods. Occasional lifting and bending to carry boxes and supplies, up to 25 pounds, may be required.