The Medical Billing/Accounts Receivable Specialist is responsible for accurate claims submission, accounts receivable follow-up, payment posting, EOB and COB processing, credit balance refunds, bad debt and collections. Using initiative to research problems and determine correct action steps to resolve eligibility, billing and account problems, and working in collaboration with an outside billing company. This may involve accessing the clinical computer system where source information resides; contacting departmental/practice representatives to obtain additional information, researching source charge entry/clinical report documents to verify information, etc. Responsible for the posting of billing information from the clinical management system to the billing system. Assist in the preparation of reports and analyses, providing feedback and recommendations to management relating to findings.
- Ensure timely, accurate and efficient processing and submission of all electronic 837 invoices and paper claims/invoices to funders.
- Perform insurance eligibility; correctly utilize ICD diagnosis codes, CPT/HCPC codes and modifiers to ensure accurate and timely payments.
- Utilize knowledge of the pre-certification and authorization process to ensure all certifications and authorizations are valid and accurate.
- Enter and maintain authorizations in the Electronic Health Record.
- Ensure compliance with billing practices, policies and procedures by leveraging strong knowledge of the policies and rules stipulated by Medical Assistance, Managed Care, Third Party, Auto Liability, Private Pay and various school districts.
- Verify client eligibility and funding changes.
- Track and report residential changes that may impact reimbursement.
- Timely submission of claim corrections and resubmission of invoices and claims when necessary.
- Maintain client billing records.
- Accurate posting of payments in the billing system to appropriate client accounts on a timely basis.
- Identify and resolve unpaid claims and report issues to supervisor.
- Weekly monitoring and monthly reporting on the status of accounts receivable over 30 days in arrears, provide details of collection efforts and issues with securing reimbursement.
- Perform collection actions including contacting funders, clients and guarantors by phone, email, and mail.
- Provide exemplary customer service to external stakeholders and internal clients.
- Work collaboratively with other departments and programs to gather and provide information on authorization and eligibility issues.
- Maintains quality results by following established policies and procedures.
- Share knowledge of current regulations, policies and developments with team members and other stakeholders.
- Maintain strict confidentiality with regard to all client information. Adheres to all HIPAA guidelines/regulations.
- Demonstrate a strong commitment to performance accountability.
- Respond to inquiries from funders and management staff regarding billing and account related matters.
- Attend relevant seminars and training sessions to improve knowledge, skills and performance as specified by the Chief Financial Officer.
- Other duties as assigned by the Chief Financial Officer or Facilities Reimbursement Manager.
- High school diploma or equivalent required
- Must have a minimum of 2 years experience as a medical biller
- Knowledge of ICD-10, CPT, HCPCS codes and claim regulatory guidelines
- Basic understanding of ICD-10 and CPT coding, CPC coding certifications are highly preferred, but not required.
- Must have experience posting insurance and patient payments
- Must have ability to explain complex billing and account information to patients and other administrative staff
- Must have experience obtaining benefit information from various commercial and governmental insurance plans.
- Must have experience obtaining authorization for medical service.
- Ability to read, write and communicate effectively in an English-speaking environment.
- Possesses strong written/verbal communication and listening skills; proactively-communicates, and modulates communication to audience. Is able to comfortably and effectively communicate with executive leaders, staff and externals.
- Acceptable under the State of Michigan's Good Moral Character Statute.
- Capable of critical thought when performing all billing-related responsibilities
- Excellent interpersonal and communications skills
- Strong ability to multi-task phones, peers, and miscellaneous tasks as needed
- Great attention to detail and processes in order to track payments and A/R follow-up
- Dependability, independent work ethic, and punctuality are a must