Billing & Collections Specialist

Billing & Collections Specialist – Orthopedic/Pain Management office 

Position Summary
To follow up on rejected claims and overdue insurance and patient balances using EOB forms and reports; build and maintain relationships with specified payors; manage patient A/R, statement processing and consider accounts for outside collections

*Looking for someone with Horizon BCBS and has prior orthopedic billing experience (would accept pain management and/or podiatry) 

Location: Linden, NJ office
Pay: Starting $22 – $26 (based on experience)

Schedule:

Full time, Monday to Friday
8am – 4:30pm
30 minute lunch break 

Requirements:
Critical Skills & Attributes

High School Diploma or GED/equivalent required
A committed and result-driven attitude to work as a high ethical and professional standard
Unquestionable commitment to confidentiality, quality customer service and professionalism

Industry Experience

Minimum of 18 months experience in a physician group practice billing department
Familiar with CPT and ICD-10-CM coding for orthopedic, podiatry & pain management surgery procedures
Good analytical skills and an affinity for detail
Knowledge of HIPPA & OSHA guidelines
Working knowledge of medical practice management systems and electronic medical records
Basic knowledge of computers and medical terminology is mandatory

Communication Skills:

Excellent verbal, written, and interpersonal skills
Ability to work well with physicians, employees, patients, and others

Key Responsibilities:

Charge Entry
Posts missing charges when discovered

Claims Filing

Reprocesses all paper and electronic claims for assigned carriers when required � verifies completeness of insurance claim information before sending
Reviews edit reports from clearinghouse daily and resolves issues so claims can be processed
Follows up on rejected claims the day that the rejected EOB is received

Claims Account Follow-Up

Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”
Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
Responds to written and telephone inquiries from patients and insurance companies; manages relationships with personnel from assigned carriers
Meets with Billing Manager regularly to discuss and solve reimbursement and insurance follow up problems
Calls carriers to appeal payments that do not match contractual agreement; notifies Billing Manager of payors for which this is a consistent problem; works with Billing Manager and physicians to obtain appeal language for denials and/or unacceptable payment
Processes requests for insurance refunds, and submits to Billing Manager for approval
Check payors monthly updates on medical policy/guidelines and report to supervisor

Patient Accounts

Establishes payment plans within approved guidelines�obtains approval from the Billing Manager when necessary
Resubmits insurance claims on behalf of patients, if necessary
Recommends to Billing Manager those accounts needing to go to an outside collection agency and sends out collection letters
Prints and mails itemized statements to those patients who request them, or transmits claims to outside mailing house for processing
Processes requests for patient refunds, and submits to Billing Manager for approval
Meets with Billing Manager, as necessary, to discuss and solve collection problems
Assist patients on claims processing if needed

Payment Posting

Posts adjustments, withholds, as part of this process, and transfers deductibles and coinsurance to patient responsibility; batches them according to protocol
Alerts Billing Manager when payments do not match contractual amounts; looks for underpayments and silent PPOs
Submits balanced payment batches to the Billing Manager daily
May be required to post all mailed-in payments and electronic payments by line item (in absence of Poster)

General

Ensure all medical information for patient is accurate, updating when necessary
Check patient eligibility and benefit verification; update account if discrepancies
Document all actions taken; scan all documents sent out to payors (ex: appeals paperwork)

Shared Duties/Other:

Ensures that all faxes are cleared off the machine (or routed in the system) and distributed throughout the day
Sorts incoming reports and directs to appropriate person if not addressed properly
Maintains detailed knowledge of practice management and other computer software as it relates to job functions
Maintains and respect the confidentiality of patient information in accordance with company policy & procedure, and HIPAA & compliance guidelines
Attends regular staff meetings and continuing education sessions as requested
Presents professional image in manner, appearance, motivation and work habits
Regular attendance is required
Performs other duties as assigned

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