Billing Specialist

Position Summary:

The Billing Specialist is a key position in two ways: First, the employee allows the patients to feel that they are being treated fairly in terms of credit and collection policies, and that their health insurance companies are being accurately billed. Second, the employee is able to directly affect the cash flow of the corporation by the abilities and knowledge of the employee, and how the employee utilizes those attributes.

Essential Functions

1. Submits and monitors insurance claims [AHCCCS, third party and/or Medicare FQHC and Medicare secondary] and assists patients with policies and procedures.
2. Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid
3. Must meet production and quality standards.
4. Responsible for daily and monthly billing processes.
5. Reviewing and appealing unpaid and denied insurance claims.
6. Responsible for posting payments, adjustments and denials from insurance companies, consumers and governmental agencies
7. Reconciles payments to various fee schedule for appropriate payment
8. Sends statements on a regular, established schedule. The Billing Specialist makes payment arrangements with patients who are unable to pay balances in full. Enforces UCHC Credit and Collection Policy with Front Desk in coordination with management.
9. Assists patients by explaining UCHC’s credit and collection policies consistently to ensure all patients are treated fairly and with respect.
10. Troubleshoots patient problems with insurance companies and any other patient financial concerns/issues in coordination with UCHC staff
11. Understands insurance companies’ procedures for submission and appeals of claims, approved CPT and ICD-9/10 coding to ensure compliance with HIPAA and health plan contractual requirements.

Additional Duties & Responsibilities

1. Ability to maintain discretion when handling confidential information. Adhere to HIPAA rules and regulations.
2. Works in cooperative fashion with other team members.
3. Demonstrates proficiency with the practice management system, appropriate to job responsibilities.
4. Must have a general understanding of accounting principles.
5. Assists staff training as needed at all levels.
6. Acts as intermediary between UCHC and patients when necessary.
7. Travels to UCHC clinic locations on an as needed basis
8. Participates in inter-disciplinary task forces and work groups as relevant.
9. Other duties as assigned.

Qualifications/Requirements

• High School Graduate plus 1or more years of experience working in claims/billing preferred.
• Reliable means of transportation and proof of valid vehicle insurance.
• Associate degree preferred in medical office administration or business administration.

Licensure/Certification

• Valid Arizona driver’s license
• Current CPR certification

Experience/Skills

• Computer literacy required with knowledge of practice management software, electronic claims, proficient in Microsoft Office products.
• Ability to communicate effectively with patients, insurance company representatives and co-workers both verbally and in writing using the English language. Ability to speak Spanish is desirable, but not required.
• Solid problem solving and decision-making capabilities and the ability to handle stressful and urgent situations primarily involving patient billing concerns.
• Well organized, ability to prioritize, good planning skills, patience, self-starter and positive attitude. Attention to detail and ability to work independently. Prior accounting/bookkeeping experience desirable.
• Ability to add, subtract, multiply and divide all units of measure, using whole numbers, fractions and decimals. Ability to compute rate, ratio, and percent and to draw and interpret graphs such as bar graphs and pie charts.
• Knowledge of medical terminology and anatomy a plus.
• A positive, professional attitude.
• A team player; able to work in and foster a team environment.