Billing Specialist

Essential Job Functions

• Prepare invoices and perform collections work on assigned patient accounts to increase cash flow and minimize patient accounts receivable.
• Meet the month-end closing deadlines by ensuring that all data entry is correctly inputted into the system
• Work with the Manager, Revenue Cycle to develop, implement, and maintain a standard accounts receivable month-end close schedule.
• Assist in development, revision, and implementation of policies and procedures for accounts receivable.
• Prepare and distribute regular reports which measure performance in relation to the goals established for third party collections.
• Participate in regular accounts receivable meetings with the Manager, Revenue Cycle to assist in defining collection strategies as they relate to particular accounts.
• Adhere to Fair Debt Collection Practices Act guidelines.
• Help to facilitate strong two-way communications between Direct Care team and the business office to promote efficient workflow.
• Provide financial responsibility estimates.
• Discuss payment and financial assistance options with patients.
• Respond timely to billing inquiries.
• Monitor and report on individual productivity to assist in the evaluation of one's ability to organize and plan daily work to meet outcome-based criteria set by Management.
• Identify barriers to billing such as lack of correct documentation, face to face requirements, and authorizations ahead of any deadlines to ensure resolution.
• Home Health/Hospice/Private Duty billing for private insurers, managed care and Medicare.
• Electronic submission of claims for non-Medicare payers and Manual submission.
• Apply payments to proper accounts.
• Customer focus on the needs and consider customer in decision-making process to ensure customer satisfaction.
• Greet the customer in a polite and professional manner whether it is on the phone, or face to face.
• Receive customer and or answer telephone calls for customer courteously, determine needs and respond appropriately.
• Respond to customer issues (intradepartmental, interdepartmental and patient based) timely and to the satisfaction of the customer.
• Identify and take appropriate action in situations when it is necessary to obtain appropriate documentation for further advancement in the adjudication process of accounts, i.e. Patient Assistance Program, third party payer appeals, re-pricing worksheets, nursing home calendars, etc.
• Motivate and influence and persuade others to build commitment.
• Act as a role model for peers by striving for excellence, display a positive attitude and actively support the team concept.
• Monitor and report on individual productivity to assist in the evaluation of one’s ability to organize and plan daily work to meet outcome-based criteria set by Management.
• Volunteer to work additional hours or offer to contribute to ongoing/special assignments outside the scope of their own specific functions.
• Communicate and provide constructive feedback and clearly express ideas.
• Communicate with lead or management all issues that impact the accurate, timely and complete accomplishment of all assigned tasks.
• Identify and communicate to lead or manager recommendations for process improvement.
• Document all accounts quickly and accurately to ensure a thorough record of actions taken and dispositions made.
• Accept and incorporate changes into daily activities.
• Possess functional knowledge of systems and revenue cycle in order to adequately assist customers and reduce the unnecessary transfer of work flows.
• Perform verifications by various modes, telephone/fax, website on-line access and/or internet access.
• Interpret and communicate insurance benefits/provisions to staff as it relates to home care billing.
• Verify and generate daily visits and patient charges.
• Perform necessary follow through to complete transactions of visits.
• Notify case managers of outstanding authorizations.
• Process the claim forms (paper and electronic) in timely and accurate manner.
• Provide follow through with manager on billing issues as they arise.
• Notify appropriate staff of any insurance changes or problems in the process as they arise.
• Process patient and insurance payments and contractual adjustments to patient accounts accurately and timely.
• Ensure correct reimbursement is paid according to the contracts/fee scheduled for both in and out of network payers.
• Apply payments to proper accounts.
• Enter authorizations under appropriate insurance and case manager.
• Enter information in a timely and accurate manner.
• Include all filing pertaining to patient’s admission to home care, palliative or hospice.
• Print in a timely manner and forward to case managers.
• Verify accuracy of request and notify staff if additional information is needed.
• Complete outstanding orders.
• Respond to inquiries and requests for additional information from third party payers.
• Work closely with Intake staff to discuss and resolve authorization issues.
• Notify Social Worker of patients with no insurance coverage.
• Bill for medical record requests.
• Cognitive ability to function and concentrate on the essential and specialty functions of the job at a high level.
• Achieves thoroughness and accuracy when accomplishing an essential or specialty function of the job.
• Ability to think and concentrate for an entire shift.
• Other duties as assigned.

Required Qualifications

• High School Diploma or GED.
• Strong leadership ability, good organizational skills, independent and critical thinking skills, and sound judgment.
• Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.

Preferred Qualifications

• Accounting/Billing Experience in Healthcare setting.

License, Certification & Clearances

• PA Act 34 Pennsylvania Access to Criminal History Clearance.

Supervisory Responsibilities

• This position has no direct supervisory responsibilities, but does serve as a coach and mentor for other positions in the department.

Position Type/Expected Hours of Work

• Regular, consistent, on-site and timely attendance.
• Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
• Travel may be expected locally between Excela Health locations.

LEAN

• Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements. Recognizes the necessity of taking ownership of one’s own motivation, morale, performance and professional development. Strives for behavior consistent with being committed to Excela’s missions, vision and values.

AAP/EEO

• Excela Health is an Equal Opportunity Employer. It is the policy of Excela Health to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants, without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, veteran status, or genetic information, or any other protected class. Excela Health will conform to the spirit as well as the letter of all applicable laws and regulations.
• Ability to perform the Essential Functions listed on the Physical Conditions and ability to perform the Essential Functions on the Working Condition chart below.

Work Environment: 

Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines

Physical Demands

When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.