Billing and Collections Specialist

GI Care For Kids•Atlanta, GA

About The Position

The Billing and Collections Specialist must be customer service oriented, detailed in performing their job functions in accounts receivables with insurance companies and self-pays, and possess the ability to manage multiple tasks daily.

Requirements

Associate’s degree, or equivalent, 3 to 5 years related experience, or Medical Billing Certification.
Experience working with medical payers including Medicaid, CMO’s and Commercial insurance.
Working knowledge of medical billing systems, particularly Epic.
Working knowledge of CPT and ICD-10 coding systems.
Ability to research and problem solve A/R disputes
Customer service oriented
A productive, dependable, self-starter
Excellent organizational skills
Proficiency in Microsoft Office Suite
Excellent verbal and written skills
Knowledge of medical billing / collection practices required
Strong keyboard skills.
Works well in environment with firm deadlines; results oriented.
Perform multiple tasks effectively.
Able to work both independently and as part of a team.
Strong analytical skills required.
Capable of making timely, independent decisions

Responsibilities

Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller.
Correcting claim issues, and/or rebilling claims to third party payers. Claims must be corrected and rebilled within the timely refiling guidelines of the insurance company assigned.
Write appeal letters.
Communicating with all departments, i.e., front desk staff, nursing and providers to ensure appropriate collection of co-pays and self-pay balances prior to patient visits.
Contact patients after obtaining auth to discuss collection of out-of-pocket expenses prior to patient visits.
Documenting the appointment desk, calling guarantors and communicating balances that need to be collected.
Handles inquiries and answers questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time
Daily monitoring of assigned insurance A/R’s, statuses on delinquent self-pay accounts, and all assigned WQ’s.
Meets deadlines of completing all assigned WQ’s prior to the end of the month.
Identifies and resolves patient billing questions in the office and incoming calls to the business office.
Daily collection and/or posting payments from insurance companies and patients as assigned daily.
Reviews accounts and makes recommendations regarding non collectible accounts when working delinquent and collection accounts.
Notifies manager of non-collectible self pays and insurance balances.
Verifies patient eligibility through various third-party sources.
Understands patient benefits from various all insurance carriers and determines out of pocket and in and out of network status prior to visits in the office.
Documents payments collected, A/R, and phone call resolutions in software system.
Understands fee schedules and updates manager of fee schedule changes and effective dates timely
Monitors changes in policy and fee schedules for all insurance carriers assigned and informs manager.
Answers business office phone calls daily and on a rotating weekly schedule.
Explain out of pocket expenses to guarantor
Assist in the enrollment and explain drug rebate programs such as Care Path and Entyvio Connect and Pfizer
Assist patients in completion of paperwork, explain and follow up patient assistance programs when needed.
Communicate effectively with professional staff and patients.
Daily monitoring of personal business office phone line, business office phone calls and emails.
Ensures voicemails are returned within a 24-hour time period.
Responds to all emails and staff messages from manager, staff and patients in a 24-hour time period
Daily collection of business office mail, and routing to appropriate billers.
Filing of manually posted payments
Cross trained to fill in for other job functions on an as needed basis.
Additional duties as assigned by management.