Billing Specialist

ENT ASSOCIATES•Clearwater, FL

18d•Hybrid

About The Position

The Billing Specialist is responsible for understanding all aspects of coding, quality assurance and compliance with Federal Payer documentation guidelines. This role works closely with departmental management and coordinates with Physicians. Posting, clean claim submission to clearing house, denials, appeals, follow-up on claims until payment received.

Requirements

High School education or GED equivalent.
Minimum of 2 years’ experience in physician office performing patient billing and collections required.
Previous computer skills on Physician Practice Management System and/or windows application with mouse.
Ability to communicate effectively with patients, physicians, and staff in a courteous manner.
Medical Terminology including CPT-4 procedure coding.
ICD-10 diagnostic coding, and HCPCS coding preferred.
The ability to attend work on a regular basis.
The ability to adhere to safety rules and other reasonable regulations pertaining to the job.
The ability to refrain from negativity or excessive irritability.
The ability to work in cooperation with other workers.

Nice To Haves

Medical Terminology including CPT-4 procedure coding.
ICD-10 diagnostic coding, and HCPCS coding preferred.

Responsibilities

Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer contract.
Review and update patient registration information (demographic and insurance) as needed.
Applies appropriate discounts/courtesies based on department policy.
Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up workflow.
Prints and mails claim forms and statements.
Retrieves supporting documents (medical records, authorizations, etc.) as needed and submits to payers.
Appeals reflected claims and claims with low reimbursement.
Confirm credit balances and gathers necessary documentation for processing refund.
Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issues causing non-payment of claims.
Monitor invoice activity until problem is resolved.
Process daily mail, edits reports, file or pull EOB batches.
Identifies and informs Manager of issues or problems associated with non-payment of claims.
Contacts payors or patients as appropriate for corrective action to resolve the issues and receive payment of the claims.
Maintaining and clearing of exceptions in the Encoda Payment Manager dashboard daily.
Daily review of outstanding checks, calling payers to identify delays and/or processing a replacement check.
Reviewing and completing the weekly statement reports to ensure any monies are moved to avoid unnecessary statement delivery to patients.
Research and answers billing and documentation questions or problems, submitted by staff, billing staff, and others to ensure compliance with specific payer regulations.
Posting of all payments and rejections (manual & electronic) in Prime Suite.
Processing and Handling of all patient and insurance refunds.
Maintain and movement of payments from credit to line-item charges, ensuring patient credit balance accuracy.
Completes daily and month-end closing.
Updates patient demographics for insurance related issues in order to accurately process claims.
Investigating and updating any returned patient statements via mail.
Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
Serves as departmental expert on coding questions.
Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with polices.
Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P Consults, ER Consults, Surgeries, medical records.
Review and resolve Encoda charge review edits daily.
Charge Entry.
Retrieve and upload sleep studies and operative notes from BayCare system.
This position will cover the duties of the Accounts Receivable Specialist, Payment Posting Specialist and Charge Entry Coding Specialist, as detailed above, as needed.