Medical Billing Specialist IV - F/U & Collections

PHI Health•Phoenix, AZ

2d•Onsite

About The Position

PHI Health is seeking dynamic, driven individuals to join their team as a Medical Billing Specialist IV, focusing on Follow-Up and Collections. This role is crucial in supporting the organization's mission of providing top-tier emergency medical services. The specialist will manage patient accounts from resubmission to final resolution, identify and address denials by writing appeal letters, and ensure account balances are correct based on payer contract terms. A strong understanding of payer-specific rules and guidelines for collections is essential to obtain timely reimbursement for services. This position offers an opportunity to make a significant impact on lives and develop a professional career within a leading air ambulance provider.

Requirements

Must have completed high school diploma (or GED equivalent) and have previous experience in medical billing/collections with a progressive increase in complexity and responsibilities.
Must have knowledge of general office procedures using office equipment.
Must have PC skills and demonstrated proficiency in Microsoft Office Word, Excel and medical billing software.
Must have prior experience with email and using the web.
Must be able to pass a pre-placement drug test and background screen.

Nice To Haves

Some college preferred.

Responsibilities

Acts as a patient advocate to obtain additional information and support for claims processing or to discuss outstanding patient balance with options available for balance resolution.
Analyze adverse billing, collections, and payer trends and report/present to management to include suggested solutions.
Assist with special projects related to payer issues or overall collections shortfalls.
Contact insurances in an assertive, consistent and knowledgeable manner in order to obtain timely payments. This includes escalation of issue to supervisors and/or grievance departments.
Categorize and quantify payer payment issues for resolution and reporting to management.
Demonstrate and maintain consistent customer focus in the face of adversity and change both internally and externally.
Demonstrate the ability to contact insurances in a consistent and knowledgeable manner in order to obtain timely payments, this includes escalation of issue to supervisors.
Demonstrates understanding of payer fee schedules, enrollment requirements along with PHI payer and facility contracts.
Demonstrates, performs an understanding of insurance collections to include payment in full (negotiation) offers, overpayment reviews and approvals, next action on correspondence, insurance types, insurance classes, in compliance with PHI's billing policies and procedures.
Draft correspondence to patients and payers including 1st level appeals for technical denials, and identify accounts to refer to Appeals Department for escalation.
Handle patient calls in support of collections activities to include financial review for charity program, payment plans, negotiation of discounts and proper resolution of patient complaints.
Maintaining a professional relationship and effectively communicating with first responders, facilities, PHI agencies, entities, insurers, attorneys and patient's
Must demonstrate positive teaming, effective cooperation in all communication within established team and throughout the entire PFS department.
Organize and prioritize work to support production goals utilizing on-line tools and required systems and software.
Participate in increasing responsibility through ongoing training and expansion of duties.
Perform financial screening for payment in full (negotiation) offers, setting up payment plans and PHI's charity program in compliance with PHI's billing policies and procedures for appropriate next required action.
Perform in-depth account review such as skip tracing, correspondence research, secondary claims billing, payment review, contractual adjustments and modify insurances/demographic information in compliance with PHI's billing policies and procedures for appropriate next required action.
Perform, identify, collect and confirm insurance coverage to include obtaining prior authorization, third party liability and coordinator of benefits.
Possess a good working knowledge of HCPCS, CPT, ICD-9, ICD10 codes, medical terminology and clinical documentation.
Provide leadership and act as a resource for management to assist, train and provide support to the PFS Billing Staff
Research, evaluate and communicate to the team, payer specific billing policies, guidelines and statutory regulations for insurance and collection follow-up.
Respond, monitor and track claims and correspondence and prioritize work accordingly to maintain and meet productions standards.
Review and evaluate any patient account for appropriate handling – regardless of age, status or payer.
Review and interpret explanation of benefits to determine contractual compliance, accuracy of payment received, true patient responsibility, status of denied or reduction of service coverage and follow up appropriately.
Take direction, coordinate projects and prioritize assignments on individual basis, as well as on a departmental/team level.
Understand billing requirements for all payers and participate in ensuring claims are accurate prior to submission; train staff on billing requirements for new and established payers.
Understand insurance regulations and guidelines to include CMS guidelines in order to effectively discuss outstanding claims with payers related to slow payments, underpayments, denials and to ensure claims are processed compliantly and paid appropriately.
Comply with Company HS&E policy and procedures.
Responsible for supporting company Safety Management Systems activities.
Understand and provide visible support of Destination Zero
Other duties and responsibilities as assigned.