Lone Star Circle of Care

  • Billing Specialist (Georgetown)

    Job Locations US-TX-Georgetown
    Posted Date 1 week ago(10/10/2018 4:34 PM)
    # of Openings
    1
    Category
    Administrative/Corporate Support
  • Overview

    The Billing Specialist follows patient accounts through the entire billing process after charge entry to completion of payment process. Performs functions as related to medical billing and collection processes by following up on outstanding claims, submitting appeals, researching eligibility and benefits, posting insurance and patient payments when applicable, discussing and collecting patient balances and assisting clinic sites with billing questions. The Billing Specialist directly affects the unit of clinic profitability by following up for payment of previously coding visits and procedures. The incumbent resolves issues with insurance companies regarding incorrect registration information, claims processing, contract reimbursement amounts and coding issues.

    Responsibilities

    Daily Job Duties:

     

    • Responsible for keeping current on requirements related to Medicaid and MCO Payers
    • Posting insurance (medical, dental, vision or pharmacy) payments/denials as assigned
    • Performing work log tasks daily to ensure encounters/claims are corrected before billing is submitted or once claim is rejected/denied. This includes all assigned tasks in your assigned payers’ worklist including but not limited to (AR tasks, Change in Payer Tasks, Posting Denial Tasks, Tasks sent by Coding, Tasks sent by EDI regarding rejections…) Priority tasks to be completed within 5 business days of the create date.
    • Produces reports to reduce age balances (AR) for assigned payers by contacting insurance companies for payment, working appeals, sending corrected claims and reconsiderations or sending secondary claims in a timely manner
    • Works a minimum of 60 encounters/claims per day for Medicaid/MCO/County Indigent/Medicare plans and a minimum of 40 encounters/claims per day for Commercial/Medicare Advantage/Market Place plans
    • Works claim denials within 5 business days of creation through Revenue Health Systems Denial Management System
    • Submits Monthly Write Off Spreadsheets timely ensuring claims are worked before the filing deadline to avoid past timely filing write offs
    • Works assigned patient refunds by the monthly deadline through Refund Manager
    • Works assigned insurance refunds via paper by the monthly deadline
    • Works organizational reports as assigned including but not limited to (patient balances, enrollment and payer audit reports)
    • Works assignments with both accuracy and efficiency to reduce errors in all areas related to encounters within the NextGen billing system including but not limited to (Change in Payers, adjustments, balance control, refunds, reading balances/credits)
    • May provide training on areas of expertise such as change in payers and payer assignments as needed
    • Communicate with coding staff for timely resolution of coding denials
    • All other duties as assigned including but not limited to (helping with department projects and working payers outside of your assigned payers)
    •  

    Customer Service:

     

    • Answers incoming calls to the billing department through PureCloud timely and with professionalism utilizing AIDET and LOC skills
    • Provides customer service to patients by educating them on insurance policies and billing procedures
    • Provides customer service to LSCC clinic staff by educating them on insurance and billing procedures
    • Provides customer service to Insurance Companies while calling to check claim status, submitting appeals/reconsiderations over the phone and while checking status on overpayment requests

     

    AIDET-LOC:

     

    • Staff Members and Directors shall deal with patients, providers, colleagues, and other internal and external LSCC contacts honestly, professionally and with empathy, following the principles of AIDET (Skill at a Glance) and the Language of Caring Overview (Staff). Staff Members and Directors shall demonstrate honesty and integrity in all LSCC business activities and work scheduling
    • Following the principles of AIDET and Language of Caring, Staff Members and Directors are expected to treat one another with respect and courtesy, understanding that each Staff Member and Director has special talents and capabilities necessary to fulfill LSCC’s Mission, Vision, and Values.
      • Principles of AIDET (Acknowledge, Introduction, Duration, Explanation and Thank You) at all times with patients, colleagues, visitors and leadership
    • The Language of Caring skills are versatile life skills that enhance communication and strengthen relationships that apply to all of us, whether we serve patients and families directly, or we serve the people who do—our internal customers.

    Qualifications

    REQUIRED EXPERIENCE, EDUCATION, AND LICENSE:

     

    • Minimum of a high school diploma and/or GED
    • Minimum, two (2) years of medical billing experience and/or two (2) years of electronic medical records experience

     

    PREFERRED EXPERIENCE, EDUCATION, AND LICENSE: 

    • Proficiency with MS Office Suite (Word, Excel, and Outlook)
    • Bilingual English/Spanish language skills are a definite plus

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