Billing Specialist

Job Summary:
We are seeking dedicated professionals for dual roles in Insurance Follow-Up and Patient Collections Specialist positions. This hybrid role integrates critical functions of the revenue cycle, including insurance follow-up, claim resolution, patient collections, and payment reconciliation. The ideal candidates will demonstrate expertise in billing processes, collections, and customer service while collaborating with team members to achieve organizational performance expectations. This position serves as a vital link between patients, healthcare providers, and insurance companies, ensuring accurate, timely, and ethical resolution of accounts.

Supervisory Responsibilities: None

Reports to: Billing Manager

FLSA Status: Non-Exempt

Requirements

Essential Duties and Responsibilities, Primary duties may include some or all the following:

• Perform   daily insurance follow-up, including claim filing, denials      management, appeals, and recoupment requests.
• Periodic report reconciliation to identify underpayments or other claims variances.
• Sending correspondence to patients.
• Proactively resolve claims edits, rejections, and corrected claims submissions.
• Handle inbound patient collection calls with professionalism and empathy, responding to inquiries promptly.
• Collect patient balances, establish repayment plans, and process payments accurately.
• Batch, send, and manage patient statements (electronic and paper) while addressing returned mail.
• Utilize worklist reports to schedule follow-ups for outstanding accounts.
• Prepare and send collection letters while maintaining compliance with organizational policies.
• Collaborate with internal teams, including coders and payment posters, to reconcile accounts and ensure accuracy.
• Maintain documentation for accounts placed with collection agencies and handle bankruptcy notices.
• Provide financial counseling to patients, explaining outstanding charges and resolving issues with a high standard of customer service.
• Stay updated on insurance payer trends, medical billing practices, and reimbursement methodologies.
• Payment Posting, Refund Requests or Posting.
• Maintaining daily reconciliation reports with payment posting.
• Refunding or requesting refunds for patients or insurers when applicable.
• Ensure compliance with revenue cycle policies and confidentiality standards.
• Maintain proficiency in EMR, Epic.
• Contributes to team success by performing other related duties as needed.  

Required Knowledge/Skills/Abilities:

• Advanced understanding of ICD-9, ICD-10, CPT, HCPCS, and their reimbursement methodologies.
• Knowledge of insurance plan types, Medicare Parts A & B, and payer-specific procedures.
• Proficient in Microsoft Office, EMR systems, and related technologies.
• Strong analytical, organizational, and problem-solving skills.
• Excellent verbal and written communication abilities.
• Ability to maintain professionalism, confidentiality, and composure in high-stress situations.
• Exceptional customer service skills and the ability to counsel patients effectively.
• Strong teamwork skills and the ability to promote a positive work environment.

Education and Experience:

• High school diploma or GED required, associate’s degree or higher preferred.
• 2-3 years of experience in a physician billing revenue cycle or central business office setting.
• Experience in patient collections and understanding payer types and explanation of benefits (EOBs).
• Preferred certification: Certified Patient Account Representative (CPAR).

Physical Requirements:

• Prolonged periods of sitting or standing at a desk and working on a computer in a stationary position. Must be able to remain in a stationary position for a prolonged period.
• Constantly operates a computer and other office machinery, such as a calculator, copy machine, computer printer.
• Must be able to lift up to 15 pounds at times and transport up to 15 pounds at a time over short distances.