ASC Billing Specialist

External Brand•Austin, TX

23d•Onsite

About The Position

PURPOSE Performs all duties required to accurately capture charges, post payments and appropriate adjustments, research and process refunds, assist patients with billing inquiries and follow up on unpaid patient balances. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

Requirements

High school diploma or GED.
Two (2) or more years of related experience working with medical billing in an ASC facility setting.
Knowledge of legislative and private sector third party regulations and guidelines.
Ability to engage others, listen and adapt response to meet others’ needs.
Ability to align own actions with those of other team members committed to common goals.
Excellent computer and keyboarding skills, including familiarity with Windows.
Excellent verbal and written communication skills.
Ability to manage competing priorities.
Ability to accurately use Ten key.
Ability to perform job duties in a professional manner at all times.
Ability to understand, recall, and communicate, factual information.
Ability to understand, recall, and apply oral and/or written instructions or other information.
Ability to organize thoughts and ideas into understandable terminology.
Ability to apply common sense in performing job.

Nice To Haves

Experience working with ANSI denial codes, CPT, ICD-9 and HCPCS coding.
Experience using computer data processing systems.

Responsibilities

Charge entry Checks coding service portal for pending items and enters charges into Epic.
Interprets managed care contracts and fee schedules to ensure charges are coded and claims processed correctly.
Verifies insurance information on file and updates if necessary Checks for implants and works with materials manager or ASC Business Office Manager for pricing accuracy.
Reviews authorizations and referrals to match coding files.
Resolves work queue rules and edits.
Notifies facility team members of any discrepancies in scheduling and coding.
Follows up on pending queries.
Monitors Waystar (clearinghouse) for rejections, updates and resubmits claim in Epic.
Payment posting Receives and prepares local and EFT payments for deposit daily.
Sorts and distributes lockbox insurance and patient correspondence.
Prepares EFT for daily posting ensuring accuracy with amount deposited daily Downloads and processes remittance ERAs from clearinghouse and various payors and completes FTP process daily.
Manually posts insurance payments and adjustments from e-remit error reports.
Prints and records all e-remit reports.
Manually posts non-ERA payments, collection agency fees, credit card payments, and insufficient funds fees and adjustments through assigned batches, according to designated deposit dates.
Generates any adjustments necessary to complete correct posting of payments and adjustments using appropriate A/R and ANSI Ensures accurate transfer of outstanding balances to next responsible party as indicated by payor explanation of benefits.
Closes, processes, balances and compiles payment posting batches daily.
Balances daily posting receipts and accurately enters all batches into Daily Receipt Activity Summary.
Patient Account and collections Assists patients with billing inquiries (phone calls and correspondence) and in establishing payment plans.
Summarizes conversation and documents findings and actions in Guarantor Account Notes.
Sets up payment plans and monitors the payment plan work queue for timely payments.
Generates collection letters according to patient AR follow up schedule.
Validates patient balances before referring an account to the collection agency.
Processes returned mail and attempts to contact patients to obtain updated demographic and/or billing information.
Refers returned mail accounts where there is no contact/unable to locate to an external collection agency.
Responds to account balance disputes in a timely manner and informs patient of audit results.
Liaises with collection agency on payments and account cancellations.
Obtains approval from manager prior to offering negotiated discounts or settlements on outstanding self-pay balances.
Processes and maintains bankruptcy files.
Refunds and adjustments Thoroughly researches and resolves all credits assigned in work queues, daily distributions, and reports.
Identifies and validates overpayments in credit work queues.
Documents findings and actions in Guarantor Account Notes.
Compiles and submits patient and insurance refunds according to established policy and procedure with all supporting documentation.
Sends Manager-approved refund file to Accounting, and once received, mails checks and supporting documentation to patients.
Refunds credit card payments (electronic).
Processes transaction adjustments approved by the ASC Billing Manager.
Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
Regular and dependable attendance.
Follows the core competencies set forth by the Company, which are available for review on ARC SharePoint.
Keeps complete, accessible, and dated files.
Provides assistance to coworkers as requested and/or necessary.
Provides workload statistic reports to management team.
Responds professionally and effectively to questions from external sources (i.e., customer or carrier) and internal sources (i.e., provider or management team).
Attends required in-services/training sessions.
Performs other duties as assigned.