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