PURPOSE STATEMENT:

The Billing and Payment Specialist is responsible for the expedient and accurate billing for treatment services posting of payments received for a group of facilities.

ESSENTIAL FUNCTIONS:

•  Responsible for billing all patient claims in a timely manner.
•  Review claims issues, make corrections as needed, and rebill. Utilize claims clearing house to review and correct claims and to resubmit electronically when available.
•  Responsible for evaluating bill cycles and changing/updating when necessary.
•  Responsible for printing daily billing reports – both electronic and paper claims. Monitor validation percent.
•  Work daily claims rejection lists.
•  Responsible for posting insurance and patient payments, contractuals, and all other adjustments.
•  Review explanation of benefits to ascertain that claim processed and paid correctly. If processed incorrectly provide detail information to collector for follow up.
•  Complete adjustment forms if any adjustments need to be made to an account and attach all supporting documentation.
•  Prorate patient accounts and monitor that balance due is in the correct financial class.
•  Maintain daily cash log noting any variances on a daily basis.
•  Gathers and interprets data from system and understands appropriate course of action to take and initiates time-sensitive and strategic steps resulting in payment.

STANDARD EXPECTATIONS:

• Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality.
• Communicate clearly and effectively to person(s) receiving services and their family members, guests and other members of the health care team.
• Develops constructive and cooperative working relationships with others and maintains them over time.
• Encourages and builds mutual trust, respect and cooperation among team members.
• Maintains regular and predictable attendance.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• High school diploma or equivalent.
• 5 years of job-related experience, preferred.
• Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
• Knowledge of office administration procedures with the ability to operate most standard office equipment.
• Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level.
• Self-motivated with strong organizational skills and superior attention to detail.
• Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes.
• Capable of working within established policies, procedures and practices prescribed by the organization.
• English sufficient to provide and receive instructions/directions.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

· Not Applicable