Billing Specialist

Independence Health System Careers•Greensburg, PA

4d•Onsite

About The Position

The Billing Specialist is responsible for preparing invoices and performing collections work on assigned patient accounts to increase cash flow and minimize patient accounts receivable. This role involves meeting month-end closing deadlines by ensuring accurate data entry, assisting in the development and implementation of accounts receivable policies and procedures, and preparing performance reports for third-party collections. The specialist will participate in meetings to define collection strategies, adhere to Fair Debt Collection Practices Act guidelines, and facilitate communication between the Direct Care team and the business office. Responsibilities include providing financial responsibility estimates, discussing payment options with patients, responding to billing inquiries, and monitoring individual productivity. The role also involves identifying and resolving billing barriers such as documentation issues, face-to-face requirements, and authorizations. Specific duties include Home Health/Hospice/Private Duty billing for various payers, electronic and manual claim submission, and applying payments to accounts. A strong customer focus is essential, requiring polite and professional interaction with patients and staff, timely response to issues, and effective communication. The specialist will also act as a role model, volunteer for additional tasks, provide constructive feedback, and document all actions accurately. Functional knowledge of systems and the revenue cycle is necessary, along with performing benefit verifications and generating daily visits and patient charges. The role requires cognitive ability to function at a high level, concentrating on essential and specialty functions with thoroughness and accuracy throughout the shift. Other duties as assigned.

Requirements

High School Diploma or GED.
Strong leadership ability.
Good organizational skills.
Independent and critical thinking skills.
Sound judgment.
Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
Cognitive ability to function and concentrate on the essential and specialty functions of the job at a high level.
Achieves thoroughness and accuracy when accomplishing an essential or specialty function of the job.
Ability to think and concentrate for an entire shift.

Nice To Haves

Accounting/Billing Experience in Healthcare setting.

Responsibilities

Prepare invoices and perform collections work on assigned patient accounts to increase cash flow and minimize patient accounts receivable.
Meet month-end closing deadlines by ensuring all data entry is correctly inputted into the system.
Work with the Manager, Revenue Cycle to develop, implement, and maintain a standard accounts receivable month-end close schedule.
Assist in the development, revision, and implementation of policies and procedures for accounts receivable.
Prepare and distribute regular reports measuring performance in relation to goals established for third-party collections.
Participate in regular accounts receivable meetings with the Manager, Revenue Cycle to assist in defining collection strategies.
Adhere to Fair Debt Collection Practices Act guidelines.
Facilitate strong two-way communications between the Direct Care team and the business office to promote efficient workflow.
Provide financial responsibility estimates.
Discuss payment and financial assistance options with patients.
Respond timely to billing inquiries.
Monitor and report on individual productivity to assist in the evaluation of one's ability to organize and plan daily work to meet outcome-based criteria set by Management.
Identify barriers to billing such as lack of correct documentation, face to face requirements, and authorizations ahead of any deadlines to ensure resolution.
Perform Home Health/Hospice/Private Duty billing for private insurers, managed care, and Medicare.
Perform electronic submission of claims for non-Medicare payers and manual submission.
Apply payments to proper accounts.
Maintain a customer focus on needs and consider the customer in decision-making processes to ensure customer satisfaction.
Greet the customer in a polite and professional manner whether on the phone or face to face.
Receive customer calls or answer telephone calls for customers courteously, determine needs, and respond appropriately.
Respond to customer issues (intradepartmental, interdepartmental, and patient-based) timely and to the satisfaction of the customer.
Identify and take appropriate action in situations when it is necessary to obtain appropriate documentation for further advancement in the adjudication process of accounts, i.e., Patient Assistance Program, third-party payer appeals, re-pricing worksheets, nursing home calendars, etc.
Motivate, influence, and persuade others to build commitment.
Act as a role model for peers by striving for excellence, displaying a positive attitude, and actively supporting the team concept.
Volunteer to work additional hours or offer to contribute to ongoing/special assignments outside the scope of their own specific functions.
Communicate and provide constructive feedback and clearly express ideas.
Communicate with lead or management all issues that impact the accurate, timely, and complete accomplishment of all assigned tasks.
Identify and communicate to lead or manager recommendations for process improvement.
Document all accounts quickly and accurately to ensure a thorough record of actions taken and dispositions made.
Accept and incorporate changes into daily activities.
Possess functional knowledge of systems and revenue cycle to adequately assist customers and reduce unnecessary transfer of work flows.
Perform verifications by various modes: telephone/fax, website on-line access, and/or internet access.
Interpret and communicate insurance benefits/provisions to staff as it relates to home care billing.
Verify and generate daily visits and patient charges.
Perform necessary follow-through to complete transactions of visits.
Notify case managers of outstanding authorizations.
Process claim forms (paper and electronic) in a timely and accurate manner.
Provide follow-through with manager on billing issues as they arise.
Notify appropriate staff of any insurance changes or problems in the process as they arise.
Process patient and insurance payments and contractual adjustments to patient accounts accurately and timely.
Ensure correct reimbursement is paid according to the contracts/fee schedule for both in-network and out-of-network payers.
Enter authorizations under the appropriate insurance and case manager.
Enter information in a timely and accurate manner.
Include all filing pertaining to the patient’s admission to home care, palliative, or hospice.
Print in a timely manner and forward to case managers.
Verify accuracy of request and notify staff if additional information is needed.
Complete outstanding orders.
Respond to inquiries and requests for additional information from third-party payers.
Work closely with Intake staff to discuss and resolve authorization issues.
Notify Social Worker of patients with no insurance coverage.
Bill for medical record requests.
Perform other duties as assigned.