Billing and Collections/Charge Entry and Reimbursement Specialist

BILLING AND COLLECTIONS/CHARGE ENTRY AND REIMBURSEMENT Specialist - Full-Time

BILLING AND COLLECTIONS DUTIES:

1.     Sending collection letters to patients that are delinquent on their bills and follow-up

2.     Responsible for setting up payment plans for accounts in arrears

3.     Answer questions for billing inquiries and insurance payment inquiries, by phone, in person and written.

4.     Send patients account information for taxes, flex accounts and itemize print outs.

5.     Insurance verification and clearances for elective procedures and prior payments arrangements for non covered items (i.e. vasectomy, IUD’s, implantable devices,

         etc.)

6.     Print out attorney requests for court action (i.e. work comp, liability suits)

7.     Post personal payments, (cash, checks, money orders & credit cards)

8.     Balance front office staff bank pouches

9.     Run and balance to credit card end of day reconciliation report

10.  Monitor overpayments and handle appropriately

11.  Post refunds and mail checks

12.  Post adjustments, split provider adjustments, collection write offs, small balances, provider reductions, etc.

13.  Monitor insurance contracts and follow up on any discrepancies

14.  Post INR home charges

15.  Post NextMD payments and reconcile to InstaMed end of day balance

16.  Post HRA payments.

17.  Move patients to own account when they turn 18

18.  Follow the unapplied list and apply to encounters as appropriate

19.  Monitor postal meter and download postage updates when applicable

20.  Import and post Medicaid ERA’s, work denials, enter electronic secondary claims into Forward Health Portal, etc.

21.  Work and follow up on late list for assigned task groups

22.  Follow up on insurance pending route slips

23.  Run Billing & Collection Reports (i.e. first OB, unity cap, estate accts, employer accts, etc)

24.  Process auto credit card payments per patient’s request

25.  Complete & fax Child Support Agency & Housing forms

26.  Monitor & clean up alerts

ADITIONAL FUNCTIONS:

1.     Handles pop and postage money

2.     Order coffee and stock in break room as needed

3.     Take certified mail to post office as needed

4.     Assists in running outgoing mail thru postage meter

5.     Assists in sorting incoming mail

6.     Assists in running claims when Insurance Specialist is out

7.     Assists in posting charges when Charge Entry person is out

8.     Assists in manual updates of new fees into File Maintenance in EPM that don’t upload

9.     Assist in working unbilled charge report

10.  Assist in posting/scanning commercial remittance advices

11.  Assist in importing and posting ERA checks

12.  Assist in working aging tasks

13.  Other duties as assigned

14.  Assists other departments as needed

15.  Attends training sessions as requested and/or desired for knowledge and expertise with position

CHARGE ENTRY DUTIES:

1.     Posts in-house charges, which have been reviewed by the Coding Department to patient’s accounts using CPT 4 and ICD 10 codes. Reviews coding rules and specific

         payer guidelines when posting.

2.     Run claim edit when posting charge, refer to appropriate Department to correct.

3.     Apply unapplied payments when applicable.

4.     Post flu shots

5.     Create encounters and post charges for Home Health certification, recertification paperwork, Nursing Home, Home INR, hospital, CCM, RPM etc.

6.     Work unapplied report

7.     Monitoring & notifying coding department when unbilled claim is approaching timely filing limit.

8.     Manage charges in holding tank, accept & decline when appropriate.

ADDITIONAL FUNCTIONS:

1.     Assist in following up on unbilled list

2.     Assist in creating encounters and posting nursing home visits.

3.     Other duties as assigned

4.     Assists in working Billing and Collection reports as needed

5.     Assists other departments as needed

6.     Attends training sessions as requested and/or desired for knowledge and expertise with position

7.     Assists in monitoring old alerts and refers to appropriate department.

REIMBURSEMENT SPECIALIST:

1.     Posts payments from commercial and contracted insurances, verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles.

        Scanning and attaching Explanation of Benefits to corresponding encounter.

2.     Posts Quic Remit credit card payments and scans Explanation of Benefits.

3.     Imports and posts Electronic Remittance Advices. Verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles. 

4.     Posts EFT payments from commercial insurances verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles. Scanning and

        attaching Explanation of Benefits to corresponding encounter. Create dummy deposit slip for balancing.

5.     Imports and posts Medicare Electronic Remittance Advices. Verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles. Create

        dummy deposit slip for balancing as Medicare funds are electronically transferred.

6.     Refers denied or incorrectly paid claims to Insurance specialist for follow up.

7.     Makes copies of EOB’s for departments where follow-up is necessary, i.e. overpayments, denials, secondary insurance, etc.

8.     Post HRA payments.

9.     Work aging task list for Unity, Unity Medicaid and Physicians Plus, primary, and secondary, referring to appropriate department for follow up when needed.

10.  Work aging task list for workers compensation and liability visits. Calling insurance companies to follow up when appropriate.

11.  Force bill electronic COB claims to secondary payers.

12.  File denied workers comp and liability claims to health insurance if applicable.

ADDITIONAL FUNCTIONS:

1.     Assists with insurance verification and clearances for elective procedures and prior payments arrangements for non-covered items (i.e. vasectomy, IUD’s,

         implantable devices, etc.)

2.     Assists with printing out attorney requests for court action (i.e. work comp, liability suits)

3.     Other duties as assigned

4.     Assists other departments as needed

5.     Attends training sessions as requested and/or desired for knowledge and expertise with position

6.     Assist in posting personal payments, verifying correct account and amount.

7.     Assist in posting insurance credit card payments and scan EOB.

• ADA: The employer will make reasonable accommodations in compliance with the Americans with disabilities Act of 1990.