Description:
AWHS Insurance Follow-Up Billing Specialist Job Description

JOB SUMMARY:

The Insurance Follow-Up Billing Specialist position is expected to meet all A/R department collection and follow-up performance expectations. The Insurance Follow-Up Specialist is a highly skilled, multi-tasking position that incorporates all key functions of the physician billing revenue cycle. This position serves as a patient-advocate through the life cycle of the account by identifying payer trends proactively in relation to zero payments, billing and denials. This position works closely with other collectors, coders and payment posters in completing claims billing & follow up collection activity while maintaining proficient results, accuracy and excellent customer service.
Reports to: Billing Manager.
FLSA Status: Non-Exempt.

REQUIRED KNOWLEDGE/SKILLS/ABILITIES:

• Excellent working knowledge of ICD-9-CM, ICD-10, CPT, and HCPCS, as well as respective reimbursement methodologies associated with each coding system required.
• Knowledge of reimbursement methodologies associated with each coding system.
• Knowledge of third-party insurance and reimbursement procedures regarding plan types: HMO, POS, PPO, Indemnity.
• Knowledge of Medicare Parts A and B insurance and reimbursement procedures.
• Knowledge of office policies and procedures to accurately answer questions from staff, physicians, and patients.
• Knowledge of administrative and clerical procedures and systems such as word processing, Microsoft Office, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
• Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Knowledge and correct usage of medical terminology.
• Ability to navigate and effectively use EMR. Knowledge and experience with Centricity EMR system is preferred.
• Ability to council patients financially regarding outstanding charges & effectively resolve issues at the highest level of customer service.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to maintain confidentiality and professionalism.
• Ability to effectively and clearly communicate in writing, over the telephone, and in person with physicians, office staff, and patients.
• Ability to work as part of a team and promote a positive work environment.
• Ability to listen and understand information and ideas and adjust actions accordingly.
• Ability to comply with all facility policies, procedures and practices.
• Ability to follow directions/instructions from supervisor.
• Ability to read and interpret medical procedures and terminology.
• Ability to exercise independent judgment.
• Ability to maintain professional attire.
• Ability to complete continued education/training requirements.
• Ability to report to work on time and as scheduled.
• Ability to represent the organization in a positive and professional manner at all times.
• Ability to communicate the mission, ethics and goals of the organization.
• Ability to apply feedback, participate in performance improvement, and continuous quality improvement activities.
• Skilled in establishing and maintaining effective working relationships with other employees, patients, and the public.
• Skilled in reviewing health care delivery against established guidelines coupled with knowledge of severity of illnesses/severity of service review criteria.
• Skilled in organization, attention to detail, and task prioritization.
• Skilled in ability to exercise independent judgement and ability to proactively look for ways to help people.
• Skilled in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Skilled in understanding patient needs to provide exceptional customer service.

EDUCATION AND EXPERIENCE:

• High school diploma or GED required, Associates degree or higher preferred.
• 2-3 years of experience in Physician Billing Revenue Cycle and Central Business Office setting.
• Experience reviewing health care delivery against established guidelines, as well as knowledge of severity of illness/intensity of service review criteria.
• Preferred certification: Certified Patient Account Representative (CPAR).

PHYSICAL REQUIREMENTS:

• Prolonged periods of sitting or standing at a desk and working on a computer in a stationary position. Must be able to remain in a stationary position for a prolonged period of time.
• Constantly operates a computer and other office machinery, such as a calculator, copy machine, computer printer.
• Must be able to lift up to 15 pounds at times and transport up to 15 pounds at a time over short distances.

• Responsible for all claim filing, including corrected claims and claim resubmission when needed.
• Maintains daily insurance follow-up including denial management, appeals reconciliation, & insurance recoupment requests.
• Responds to patient account inquiries in a timely manner.
• Follows through with claims edit resolutions and claims rejection resolution.
• Maintains integrity of medical records/claims data.
• Assists other departments with questions and issues regarding patient accounts.
• Complies with revenue cycle policies and procedures.
• Maintains advanced knowledge of physician billing and accounts receivable systems.
• Meets department production standards consistently as defined by department management.
• Maintains working knowledge of the EMR system and any technology needed for the position.
• Meets department production standards consistently as defined by management.
• Other duties as assigned and/or requested by your supervisor or management.
  Requirements: