Billing Representative

Our OBGYN practice is seeking to enhance our billing staff with the addition of a new full-time member to our dynamic team. The right candidate should possess a desire to provide high-quality customer service with efficiency and compassion. A growth mindset is vital in this position as we all have an opportunity to learn more every day.

JOB SUMMARY:

Manages the follow-up of claims from payers and self-pay collections. Develops, recommends and implements policies; provides in-service education; provides directions and guidance on the interpretation of policies as they relate to company objectives; addresses employee’s, patient’s and physician’s billing issues; maintains strict confidentiality regarding patient accounts.

ESSENTIAL JOB RESPONSIBILITIES:

1. Ensures that the follow-up of all insurance claims meets expected cash flow and that days to pay are at or below the benchmark.
2. Identifies and monitors payer aging where increases have occurred and takes appropriate action.
3. Provides analytical support of accounts receivable to ensure maximum 3rd party reimbursement.
4. Communicates changes in 3rd party policies relative to OB/GYN specialty.
5. Analyzes month-end reports, payments and 3rd party rejections.
6. Makes recommendations to improve billing process and generate revenue.
7. Follows up with insurance companies to ensure timely payment or action taken to preserve the financial rights of our clients.
8. Serves as a liaison in responding to patients’, payers’ and external agencies’ complaints and concerns including potential liability matters in concert with risk management guidance and approval on legal issues.
9. Establishes an accurate and timely process for the posting of all cash and allowances (ensures that all receipts are reconciled and accounted for) utilizing electronic processing where available, making certain that all items are applied to the correct patient accounts. Identifies and ensures refunds are processed in a timely manner.
10. Ensures that the billing procedures are conducted in a manner consistent with overall department protocol and compliant with Federal, State and payer regulations, guidelines and requirements.
11. Handles the insurance mail that includes denials, zero pay accounts and other accounts involving improper reimbursement.
12. Assists in providing reimbursement and revenue maximization analysis and education to all staff.
13. Handles billing questions from patients, team members and providers.
14. Monitors metrics by running reports in the required timeframes with timely follow up.
15. Applies proper coding principles when filing claims to the insurance payors.
16. Stays informed of changes and requirements with payors and communicates to the staff.
17. Performs miscellaneous job-related duties as assigned by management.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

1. Knowledge of billing procedures of Medicare, Medicaid, and private insurers and understanding of financial billing requirements.
2. Knowledge of ICD-10 and CPT coding.
3. Knowledge of organization structure, workflow and operating procedures within a high-volume medical billing environment.
4. Knowledge of Federal, State and payer regulations regarding medical billing compliance.
5. Knowledge of mainframe-based medical billing and editing systems.
6. Skill in keyboarding and knowledge of Microsoft Office programs.
7. Skill in establishing and maintaining effective interpersonal relationships.
8. Skill in listening to others, assessing situations and solving problems.
9. Ability to display customer focus and professionalism and to exhibit team-building skills.
10. Ability to communicate effectively both verbally and in writing.

EDUCATION, CERTIFICATION AND EXPERIENCE:

1. High school diploma or equivalent.
2. 3-5 years of experience within medical billing, collections and/or reimbursement.

WORKING CONDITIONS:

This job is typically performed in a normal office environment, with very little physical effort or exposure to physical risk.