Insurance Verification/Billing Specialist

SUMMARY OF RESPONSIBILITIES

• The Patient Financial and Billing Representative is responsible for assisting patients with financial and billing inquiries. He/she is also responsible for running and providing accurate reports to multiple departments regarding a variety of data.

ESSENTIAL FUNCTIONS

• The Patient Financial and Billing Representative with assist with eligibility for scheduled visits in clinic and ASC setting.
• Responsible for assisting with cost estimates for scheduled procedures in ASC setting.
• Reviews patient bills for accuracy and completeness and obtaining any missing information.
• Calls insurance companies for clarification on benefits for patients when necessary.
• Identifies and bills secondary or tertiary insurance.
• Reviews accounts for insurance of patient follow-up.
• Answers all patient or insurance telephone inquiries pertaining to assigned accounts.
• Sets up patient payment plans and work collection accounts.
• Updates billing software with rate changes and notifying all necessary departments of the changes in a timely manner.
• Runs accurate Front desk collection reports monthly and reporting to appropriate staff.
• Is the primary point of contact for Patient Support Representatives for all billing inquiries and assisting patients with understanding their charges and outstanding balances.
• Assists patients with coordination of benefits and notifying staff when they have been resolved.
• Maintains a comprehensive knowledge of the policies of all insurance carriers, including Medicare and Medicaid, that PTCOA, AFCI, and FCCOA accept.
• Maintains a comprehensive knowledge of all providers credentialing status with each individual entity.
• Actively assist patients with understanding their out-of-pocket expenses, explaining benefits including co-payments, co-insurance, deductibles, and coordination of benefits. Patients should know what they are expected to pay at the time of service.
• Explains and arranges patient payment plans, alternative financing, and charity programs.
• Processes patient payments and correctly updates patient accounts and balances.
• Assists in overseeing accurate cost estimates are provided to the patient.
• Assists patients with financial assistance applications in accordance with PTCOAs financial assistance policy.
• Performs other related duties as assigned.

CORE COMPETENCIES

• Excellent oral and written communication skills
• Excellent skills in customer service and communications
• Knowledge of current medical terminology to communicate with physicians, staff, and patients.
• Strong telephone communication skills
• High level of attention to detail
• Strong organization, filing, and time management skills.
• Basic computer literacy and typing
• Patient focused.
• Self-starter and comfortable with working independently while providing timely and accurate status reports.
• Ability to prioritize and manage multiple tasks without direct supervision.
• Multi-tasking abilities, along with ability to work well under pressure, prioritize and meet tight deadlines.
• Must be able to work independently in a fast-paced environment and exhibit strong written and verbal communication skills.
• Strong customer service and prompt problem-solving skills including the ability to provide diligent, prompt, and courteous responses to patient questions/issues.
• Take initiative to do to redo inadequate or incomplete work, even if it is not yours.
• Ensure compliance with regulatory standards.
• Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Minimize non-productive time and fill slow periods with activities that will enable you to prepare to meet the future needs of the company (education, organizing, housekeeping, assisting others).
• Organize job functions and work area to be able to effectively complete varied assignments within established time frames.
• Consistently demonstrate ability to take the initiative to make decisions/choices without direct supervision.
• Adhere to administrative and departmental policies.
• Demonstrate regular attendance and timeliness.
• Do not incur excessive overtime.
• Remain conscientious in regard to personal hygiene.
• Demonstrate knowledge and understanding of all policies and procedures and ability to reference them from appropriate sources.
• Demonstrate adherence and support of company-wide service standards as evidenced by observation and feedback from patients, family members, and other clients.

REQUIRED EDUCATION, EXPERIENCE, AND/OR CERTIFICATIONS

This is a full-time position. Days and hours of work are expected to fluctuate but at a minimum this position will be required to work from 8:00 a.m. to 5:00 p.m. (Monday through Thursday) and 8:00 a.m. to 12:00 p.m. (Friday), and occasionally after regular business hours. Travel may be required. The position operates in a professional office environment and the incumbent, in the course of performing this position, spends time writing, typing, speaking, listening, driving, seeing (such as close, color and peripheral vision, depth perception and adjusted focus), standing, sitting, walking, and reaching. The incumbent operates all standard office equipment, motor vehicles, and mobile phones. The work environment characteristics and physical demands described here are representative of those the incumbent can expect to encounter while performing the essential functions of this job.

WORKING ENVIRONMENT AND PHYSICAL DEMANDS

This is a full-time position that may work standard business hours four to five days per week. Days and hours of work are expected to fluctuate significantly but at a minimum require work before, during, and after regular business hours. Presence in the office is required. The position operates in a professional office environment and will require significant time writing, typing, speaking, listening, driving, seeing (such as close, color and peripheral vision, depth perception and adjusted focus), standing, sitting, walking, and reaching. Operation of all standard office equipment, non-CDL motor vehicles, and mobile phones and related technology, is expected. The work environment characteristics and physical demands described here are representative of those an employee encounters while performing the essential functions of this job.