Billing Specialist

PRIMARY DUTIES

• Maintain a current knowledge of insurance carrier and/or state program claims filing policies and procedures
• Verify patient demographics and financial coverage; update as needed
• Research and verify patient and/or insurance company and/or state program refunds/recoupments
• Adjust patients accounts to reflect changes in payment responsibility
• Verify accuracy of information on paper medical claim forms and mail to selected insurance carriers and/or state programs
• Research patient charges not automatically assigned to selected insurance carriers and/or state programs, make corrections and assign manually
• Maintain patient accounts; give GHC program discounts and/or other adjustments as needed
• Appeal service charges rejected by selected insurance carriers and/or state programs and resubmit amended claim forms
• Process claims/vouchers as needed for insurance plans and/or state programs
• Obtain pre-certifications, prior-authorizations, or referrals for special provider services as needed
• Verify motor vehicle or accident information with patient’s insurance carrier
• Maintain work ques with claim errors
• Assist insurance carriers and/or state programs to acquire supplemental patient information needed to process claims
• Assist patients to understand fees for services and billing processes
• Assist patients to make payment arrangements and find financial assistance
• Assist outside providers and vendors to obtain physician billing information
• Assist employees to understand policies and procedures related to billing matters
• Communicate and support training issues with billing staff
• Comply with all regulations related to confidentiality of patient information
• Maintain and/or create new payor and plans as needed
• Able to manage multiple priorities and manage stress appropriately
• Communicates appropriately and clearly with a pleasant and professional manner to all
• Demonstrates excellent judgment in handling situations not covered by written or verbal instructions
• Demonstrates a commitment to the mission, core values, and goals of Waco Family Medicine and its healthcare delivery including the ability to deliver exceptional patient focus with quality, compassion, and respect
• Maintain certifications and website passwords as applicable

OTHER DUTIES

• Assist in scheduling patient appointments

• Process billing statements and balance notification letters to patients
• Assist patients to make payments on owed balances
• Provide follow-up on patient’s payment arrangements
• Assist with daily mail duties
• Provide backup support for clerks and other billing staff as needed
• Other duties as assigned by supervisor

PHYSICAL AND MENTAL REQUIREMENTS:

• Visual and auditory accuracy
• Shift length – 8 hours
• Indoor setting
• Continuous use of computer, calculator
• Long periods of sitting and walking
• Frequent use of telephone
• Frequent use of stepladder
• Continuous repetitive grasping and manipulation of both hands
• Continuous conversational communication
• Occasional reaching, standing, squatting, bending, kneeling, twisting and climbing
• Occasional carrying, lifting, pushing and pulling of up to 10 Lbs
• Infrequent use of personal transportation
• Working in a frequently noise environment
• Continuously working in a tight area
• Understand/carry out simple/detailed, oral/written instructions
• Memorize and retain instructions
• Read and interpret detailed specifications.

REPORTS TO:  Director of Billing Services

EDUCATION:  High School Diploma or Equivalent required, College Hours preferred

SKILLS:   Computer literacy, knowledge of ICD-10 CM/CPT coding, medical office billing and collection practices, federal/state/local financial assistance programs, strong interpersonal, oral, and written communication skills, excellent telephone, and customer service skills.