Medical Billing & Collections Specialist

The Billing & Collections Specialist's role is to perform collection and follow-up activities related to claim payment for the Billing department. Responsibilities include billing, posting payments, and performing simple arithmetic computations. Work is performed according to established procedures and is reviewed or monitored frequently until familiarization with billing and collection procedures is achieved.
Expectations, Duties, and Responsibilities:

• Prepares and submits clean claims to third-party payers either electronically or by paper.
• Maintains relationship with the clearinghouse, including appropriate follow-up with support and collection issues.
• Coordinate collection process.
• Manage monthly statement process, to include reviewing statements before mailing and field any patient inquiries the Receptionists need to escalate.
• Handles patient inquiries and answers questions from clinical staff, receptionists,s and insurance companies.
• Identifies and resolves patient billing problems.
• Denial and insurance follow-up management.
• Issues adjusted, corrected, and/or rebilled claims to third-party payers.
• Reviews accounts and makes recommendations regarding non-collectible accounts.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Bill, post payments, and perform follow-through on outstanding balances.
• Search for patient demographics and insurance.
• Run collection reports/workflows for all unpaid claims.
• Reviews, corrects and classifies invoices for accuracy and completeness.
• Prepares credits or refunds when required and forward to accounts payable.
• Determine if additional documentation is required prior to billing.
• Demonstrates continuous effort to improve operations, decrease turnaround times, streamline work processes and work cooperatively and jointly to provide quality work.

Knowledge, Skills, and Qualifications:

• High School education. College education and/or equivalent work experience preferred;
• Understand RescueNet (RN), Navinet, Zirmed, EMS Charts, and various insurance websites, preferred;
• Knowledge of Medicare rules and regulations · Electronic claim submissions and remittance procedures.
• Commercial insurance claim requirements.
• Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance.
• Excellent written and verbal communications skills required · Excellent documentation skills (promptness, accuracy, thoroughness, and legibility).
• Must be highly organized;
• Excellent (or established) inter-personal skills;
• Knowledge and expertise with Microsoft Products preferred, specifically Excel and Word;
• Working knowledge of EMS systems/private ambulance and medical transportation systems preferred;
• Computer proficiency preferred.

An AAEO Employer.