Overview:
Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution.
Special Instructions: Position is On-Site with Hybrid work option after at least six months Responsibilities:
- Promote the mission, vision, and values of the organization
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Import charges from queues in a timely manner and append modifiers or any required information for claim transmission
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Review daily accounts that are ready to be billed in Waystar from Meditech
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Initiate correction on all claims with errors by the designated time
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Follow up on any correspondence that may have been received on that day or the previous day
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Cross train on billing all lines of business to the different payers
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Pull listing of all accounts assigned to be follow up by specific payer
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Diagnostic and procedural coding
Follow-Up Responsibilities
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Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
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Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.
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Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts.
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Maintain accounts receivable detail of their accounts through tasking.
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Maintains standards per payer for percentage accounts >90 days.
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Works minimum standard number of accounts per payer per day.
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Meets or exceeds collection goals by payer each month.
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Works all assigned accounts as assigned, depending on balance.
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Complete appeals as required.
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Participates in educational activities and attends monthly department staff meetings.
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Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
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Other duties as assigned from time to time.
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Attend educational activities and monthly department staff meetings
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Perform other duties as assigned
Qualifications:
- High School Diploma or GED
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Six months previous experience in clinic registration, billing and collections, financial counseling, or customer service preferred
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Knowledge of medical terminology preferred
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Basic computer proficiency
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Typing speed: minimum 40 WPM
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Familiarity with CPT and ICD-9 coding is helpful
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Good written and verbal communication skills are essential for account follow-up