Billing Specialist
Responsible for effectively billing or rebilling all accounts to the appropriate insurance carrier by implementing billing procedures in a timely manner. Responsible and accountable for pursuing collection of all receivables from insurance, guarantor, and/or any other responsible party.
Principal Duties And Responsibilities
- Continually follows-up on outstanding accounts through contacts/inquiries to third party payors to facilitate prompt resolution and/or payment and actively pursues payment from patient/guarantor on all outstanding account balances after third party payment or rejection based upon hospital collection guidelines daily.
- Identifies and investigates delinquent accounts to for special circumstances affecting payment delays and recommends the appropriate disposition.
- Reviews bad debt prelist report to ensure that adequate follow-up/collection efforts have been performed prior to transferring to the bad debt file weekly.
- Phones patients to obtain insurance and COB information and inform them of financial responsibility and discusses various payment options.
- Prepare appropriate billing documents based upon current payor/hospital guidelines for all third party payors.
- Prepares and processes any necessary adjustment/coding changes on accounts through the system based upon follow-up to expedite the collection process and to ensure the accuracy of the account daily.
- Review inpatient and outpatient fins to ensure the accuracy and completeness of all documents.
- Reviews audit discrepancy report, pulls the account, processes the debit/credit adjustments, rebills the account to the third party payor and moves monies back to the insurance load.
Job Specifications
- Knowledge of UB-04 and 1500 billing preferred.
- Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
- Productivity Standards of 75 accounts a day, minimum.
- Quality Standards of 95% A/R aging 90 days less than 30% of total A/R.
- Accounts on WQ's can not be aged more than 30 days.
- Mail and correspondence must be worked within 5 working days.
- Medical Records request follow-up must be worked within 7 working days from first request.
- Account rejections in Quadax must be turned around within 2 days of receipt.
- Follow up with UM or physicians office on Prior Authorization denial within 1 day of receipt.
- Bad debt accounts to be worked weekly and completed by month end.
- Resolve and complete patient complaints daily.
- Denial Write-Off rate needs to be