Billing and Collections Specialist-FT-Days-Billing & Collections-Revenue Cycle

DHR Health  -  US:TX:Edinburg - Days

Summary:

FLSA STATUS: ☐ Exempt ☒ Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

 

POSITION SUMMARY:

 

This position is responsible for business office activities which include collection of accounts receivable, patient billing, customer service, cashiering, refunds/recoupment's, and provides refunds for services to patients and third party payers as needed. Understanding of Insurance Plans and coordinating with Hospital Departments. This position requires all of the above functions to be performed as needed.

 

POSITION EDUCATION/QUALIFICATIONS:

• High School Diploma/GED required
• Comprehensive knowledge of healthcare reimbursement.
• Understands medical terminology
• Familiarity with EOB’s and RA’s
• Knowledge of Microsoft Office suite, working knowledge of Excel required.
• Excellent Customer Service
• Good written and verbal communication skills required
• Must be able to multi-task and work with frequent interruptions
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of management
• Bilingual – English/Spanish, preferred
• MD billing office experience required, hospital experience (1-2 years) preferred.
• MD billing office experience required, hospital experience (1-2 years) preferred.

JOB KNOWLEDGE, SKILLS, AND EXPERIENCE­:

• Communicates clearly and concisely; and is able to work effectively with other employees, patients and external parties
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
• Medical Terminology, ICD-10 Codes, CPT Codes, HCPCS code, Modifier knowledge is preferred.
• Requires reasoning ability, good independent judgment and working with frequent interruptions.
• Ability to use the internet to obtain information from Third Party Payers or other sources is required

Responsibilities:

POSITION RESPONSIBILITIES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Receives incoming and outgoing calls from patients and informs them of their balance due after insurance has paid.
• Perform daily billing, including abstracts, interim bills, late charges, re-bills and split bills
• Transmits all claims worked by billers to all insurance carriers three times a day as needed
• Submits professional 1500 claims as needed
• Works claims that have been placed on hold to ensure bills are released timely.
• Assist patients with questions and concerns regarding the billing of their accounts.
• Downloads and posts the electronic remit acknowledgement reports as needed
• Works the exclusion and rejection reports from Claims Administrator and makes any needed corrections, re-bill claims and balances daily billing
• Serves as a resource for billers, collectors, customer service, appeals staff and other departments.
• Works billing not imported report as needed
• Monitors MD’s with no NPI numbers and locates them in order to update system for billing compliance
• Monitors Patient account system billing report and outstanding billing report as needed
• Monitors billing edits and releases and makes updates as needed.
• · Maintains account status changes: upgrades/downgrades, conversion accounts and account merges using 24 hour and 72 hour reports in accordance to CMS guidelines as needed
• Responds to all mail, email and phone calls in a timely manner.
• · Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
• · Cross train with other Business Office Specialist.
• Obtains copies of required insurance identification cards, as needed.
• Follows-up accounts on assigned ATB and/or custom reports and contacts insurance carrier for payment and/or recoupments.
• Enter appropriate mnemonic in the notes tab
• Utilizes tickler, when requesting additional information from other co-workers or departments
• Responds to correspondence from insurance carriers in a timely manner.
• Determines financial status and refers patient for financial screening as appropriate and as needed
• Ability to identify accounts that need insurance billing or rebilling
• Adheres to collection tips booklet when contacting insurance carrier
• Demonstrates proficiency in billing and follow up of Medicare, Medicaid claims on-line or through billing software
• Proficient in accessing information needed from Patient Accounting System and other Applications.
• Request copies of medical records from HIM for any paper records
• Ability to access medical records from EMR system to appeal claims with carriers.
• Enter and maintain appealed accounts through the Patient Account System.
• Maintain Application software system for carrier over and under payments to facility.
• Create appeal and patient letters with appropriate details as needed
• Select correct adjustment codes on adjustment form to appropriately document reason for adjustment
• Complete adjustment form appropriately with the correct dollar amount assigned to the adjustment code
• Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
• Assist with posting payments and identifying correct I-plan as needed
• Daily download and review report of patient balance for statement release as needed.
• Update address on return mail
• Review RAs and EOB’s total charges, amount of insurance payment and balance owed by patient or responsible party.
• Explains hospital payment policies and collects patient balance due and writes receipts for all payments collected.
• Performs daily reconciliation of petty cash as needed
• Download and post electronic remits and apply payments and adjustments as per I-plan as needed.
• Make deposits to the bank as needed.
• Researches credit balances for accurate processing of refunds due to over payments and/or allowances requiring a correction in a timely manner as needed.
• Prepares credit worksheet and processes all transactions required to request refund checks or to correct account balances as needed.
• Transfers patient credit balances to outstanding accounts according to hospital policy and procedure, and prepares letters of explanation concerning refund issued to third party payers and patients as needed.
• Researches and prepares quarterly Medicare credit report as needed.
• Responds to all mail and phone calls concerning credit balances and refunds checks as needed.
• Other duties and special projects as needed.

Other information:

LINES OF REPSONSIBILITES:

(Chain-of-command)

1. Supervisor → 2. Director → 3. CRO

 

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

 

AGE SPECIFIC:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

Light/moderate lifting up to 20 lbs, from the floor to shoulder height.

Yes

Kneeling

Yes

Must be able to assist other employees with lifting more than 20 lbs.

Yes

Walking

Yes

Light/moderate carrying up to 20 lbs.

Yes

Standing/Squatting

Yes

Straight pulling

Yes

Sitting

Yes

Pulling hand over hand

Yes

Pushing

Yes

Repeated bending

Yes

Stooping/Bending

Yes

Reaching above shoulder

Yes

Climbing Stairs

Yes

Simple grasping

Yes

Climbing Ladders

No

Dual simultaneous grasping

Yes

Depth Perceptions needed

Yes

Ability to see

Yes

Identify Colors

Yes

Operating office equipment

Yes

Twisting

Yes

Operating mechanical equipment

Yes

Crawling

No

Ability to read and write

Yes

Ability to Count

Yes

Ability to hear verbal communication without aid

Yes

Operating Personal Vehicle

Yes

Ability to comprehend written/verbal communication

Yes

Other: Ability to deal with stress

Yes

OSHA Category

III

 

 

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: ________________________.