Clinical Billing Specialist

Job Summary:

The Clinical Billing Specialist is responsible for the day-to-day clerical and accounting functions for patient billings including coding, sending invoices to collect payment from patients and their insurers, maintenance of third-party billing records, resolution of problems, while working collaboratively with the billing team and Customer Service Representatives to ensure a successful revenue cycle.

Supervisory Responsibilities:

None.

Duties/Responsibilities:

1. Posts charges for all providers (medical, dental, behavioral health) and ensures they are posted to the highest level of specificity with appropriate modifiers, place of service codes, CPT codes, etc.
2. Responsible for sending all claims to insurance or third party payers and working the edits and rejections to ensure they are received by the payer.
3. Posts payments both insurance/third party and patient/self-pay accurately, as per explanation of benefits, 835 files or statements received and reconciling back to bank statements to ensure the payment has been received.
4. Works denied claims and sends appeals to ensure we are capturing revenue as per insurance/payment policies.
5. Performs claim follow-up to ensure payers are processing timely and accounts receivable is within normal range, as per performance indicators for clinics of this stature.
6. Conducts charge reconciliation at month end to ensure all charges/encounters are captured for the month to ensure a clean month end.
7. Performs payment audits to ensure accurate payment rates, as per our payer contracts, as well as reviewing charges to ensure rates are set correctly relative to payments.
8. Answers phone calls from patients regarding billing, statement or insurance questions and working with patients to ensure their needs are met.
9. Collects delinquent accounts by establishing payment arrangements with patients, monitoring payments and following up with patients when payment lapses occur.
10. Processes statements and reviewing for accuracy.
11. Identifies/verifies patient’s insurance coverage or other sources of payment and works closely with CSR staff.
12. Performs 0ther duties as assigned.

Duties 1 through 11 are designated as ADA Essential Functions and must be performed in this job. All other job duties are secondary functions.

Knowledge, Skills, and Abilities:

• Ability to efficiently carry out Midtown Health’s Center mission statement and comply with its policies and procedures.
• Ability to establish and maintain effective working relationships with patients, co-workers, and the public and to be able to demonstrate cultural awareness and sensitivity.
• Must be able to maintain strict confidentiality of sensitive information in accordance to HIPAA regulations.
• Ability to comply with all occupational safety and health standards and all rules, regulations, and orders issued under the Occupational Safety and Health Act (OSHA).
• Ability to utilize critical thinking and problem solving skills to address clinic’s needs.
• Ability to interpret oral and written instructions and do appropriate follow-up.
• Ability to work independently and as a team member.
• Must have exceptional time management and organizational skills.
• Ability to constructively participate in quality improvement efforts.
• Bilingual (English/Spanish) verbal and written skills highly desired.
• Proficient in Microsoft Office applications and data base application.
• Ability to operate standard office equipment including, but not limited to computers, printers, copiers, scanner, calculators, facsimile machines and telephone systems.
• Ability to run a multi-line telephone system.
• Must have a general knowledge of medical terms.
• Solid understanding of billing software and electronic medical records system.
• Must understand the differences between and among self-pay patients, insurance patients, Medicare patients, workers’ compensation patients, and occupational medicine patients.
• Must have excellent customer service skills, including de-escalation.
• Must have strong oral and written communication skills.

Education and Experience, Licensure and Certification:

• High School diploma or equivalent required.
• Medical Billing degree/certificate preferred.
• Appropriate experience may be substituted for minimum education requirement.
• 1-2 years of Medical Billing Experience preferred.
• Experience with HMOs, PPOs, Medicare and Medicaid.
• Must have a valid driver’s license and the ability to utilize own transportation for work purposes.