Medical Billing & Collections Specialist II

Job Description Summary

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Must be able to handle high volume call Queue regarding patient billing questions as well as timely response for patient portal messages. Must have strong communication and listening skills as well as strong knowledge of medical billing and claims processing.

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How will you make an impact & Requirements

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The Revenue Cycle-CSR is responsible to provide support to patients, providers and customers internally and externally on billing related inquiries. The employee works insurance claims and patient accounts using department guidelines and MPG electronic systems. The position requires a thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences. Also requires understanding of how to decipher explanation of benefits and explain the impact to the customer. Position requires the ability to conduct both telephone, portal and face to face meetings with patients regarding account resolution and payment collection. Assist customers with hardship applications, payment plans and eligibility for services. Expert verbal communication, interpersonal skills and professional appearance required for dealing with customers. Additional duties as required.

Job Standards:

Demonstrate excellent interpersonal skills with patients, co workers and insurance carriers.

Well-versed with all HIPPA Guidelines to ensure the protection of patient information from unauthorized inquiries.

Process and post payments to accounts same day

Resolve patient complaints within a minimal timeframe, same day whenever possible.

Meet timelines for reprocessing Athena claims after updating the account with new information as provided by patients or physicians within the guidelines and timeframes permitted by the insurance carrier.

Advanced knowledge of CPT and modifiers

Phones answered & voicemails returned within same day/next day as per department metrics.

Claim adjudication carrier rules knowledge

Conducts themselves in accordance with MPG Policies and Procedures including the Code of Conduct.

Meets or Exceeds monthly performance goals, expectations and reviews

Uses Paid Time Off effectively

Keeps overtime to a minimum/has any overtime approved by Manager

Communicates call trends to managements when needed for possible escalation.

Actively participates in team meetings and educational opportunities

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Receipt and Acknowledgment:

I acknowledge and understand that:

• Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind, and that my employment is at-will.
• The job description provides a general summary of the position in which I am employed, that the contents of this job description are job requirements and, at this time, I know of no limitations which would prevent me from performing these functions with or without accommodation. I further understand that it is my responsibility to inform my supervisor at any time that I am unable to perform these functions.
• Job duties, tasks, work hours and work requirements may be changed at any time.
• Acceptable job performance includes completion of the job responsibilities as well as compliance with the policies, procedures, rules and regulations of the Home and the Corporation.