Medical Billing & Collections Specialist II

Mosaic Health•Fort Myers, FL

About The Position

The Revenue Cycle-CSR is responsible to provide support to patients, providers and customers internally and externally on billing related inquiries. The employee works insurance claims and patient accounts using department guidelines and MPG electronic systems. The position requires a thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences. Also requires understanding of how to decipher explanation of benefits and explain the impact to the customer. Position requires the ability to conduct both telephone, portal and face to face meetings with patients regarding account resolution and payment collection. Assist customers with hardship applications, payment plans and eligibility for services. Expert verbal communication, interpersonal skills and professional appearance required for dealing with customers. Additional duties as required.

Requirements

Strong communication and listening skills.
Strong knowledge of medical billing and claims processing.
Thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences.
Understanding of how to decipher explanation of benefits and explain the impact to the customer.
Expert verbal communication and interpersonal skills.
Professional appearance required for dealing with customers.
Well-versed with all HIPPA Guidelines to ensure the protection of patient information from unauthorized inquiries.
Advanced knowledge of CPT and modifiers.
Claim adjudication carrier rules knowledge.
Conducts themselves in accordance with MPG Policies and Procedures including the Code of Conduct.
Meets or Exceeds monthly performance goals, expectations and reviews.
Uses Paid Time Off effectively.
Keeps overtime to a minimum/has any overtime approved by Manager.

Responsibilities

Handle high volume call queue regarding patient billing questions.
Provide timely response for patient portal messages.
Work insurance claims and patient accounts using department guidelines and MPG electronic systems.
Conduct telephone, portal and face-to-face meetings with patients regarding account resolution and payment collection.
Assist customers with hardship applications, payment plans and eligibility for services.
Process and post payments to accounts same day.
Resolve patient complaints within a minimal timeframe, same day whenever possible.
Meet timelines for reprocessing Athena claims after updating the account with new information as provided by patients or physicians within the guidelines and timeframes permitted by the insurance carrier.
Answer phones and return voicemails within same day/next day as per department metrics.
Communicate call trends to management when needed for possible escalation.
Actively participate in team meetings and educational opportunities.