A Billing and Reimbursement Specialist is responsible for the accurate and timely billing, follow up and payment for assigned accounts. Responsible for complete resolution of all aspects of insurance payment for claims assigned. Goal is to assure prompt, accurate reimbursement for services rendered.
- Minimum high school diploma or GED, with two years experience working in an accredited hospital or physician office preferred
- EPIC or Revenue Cycle Certification a plus
- Ability to work independently with minimal supervision
- Good oral and written communication skills.
- Proficiency with computer functions, including ability to use automated systems for third party billing and insurance follow up.
- Professional, business-like appearance and demeanor
- Recognizes and reports problems, errors and discrepancies to management
- Shares information with co-workers
- Ability to contribute to team efforts
- Ability to assist with training of new employees as needed
Essential Functions and Responsibilities:
- Works closely with Hospital and/or Physician office staff to assure correct information is obtained for billing purposes.
- Reviews claims daily, prior to submission to payers, for accuracy utilizing electronic billing software
- Reviews and takes action on claims returned by payers, whether denied or underpaid
- Ability to post payments and reconcile vouchers according to department standard workplan
- Responsible to validate the payments and adjustments made on accounts are correct
- Maintains daily work queues according to payer requirements, including late charges/credits, multiple visits in one day, 3-day rule, changes in insurance coverage, and claim errors
- Files claims to payers in a timely manner to assure prompt reimbursement
- Prepares Medicare Bad Debts following CMS guidelines
- Ability to analyze reports from third party vendors for self pay balances.
- Responsible for quality and productivity standards established by management
- Complete knowledge of payer guidelines, including utilization of payer websites and other tools
- Other duties as assigned.