Blending
Care
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Billing and Collections Revenue Cycle Specialist
Location: San Jose, California
Date Posted: 15 Jun, 2022
Description-
SUMMARY
Under the general direction of the Revenue Cycle Management Supervisor this position is responsible for the medical billing and collection specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and collection specialist must possess critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments base on payer contracts or government regulations. In addition, the medical billing and collection specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims
ESSENTIAL DUTIES AND REPONSIBILITIES
· Responsible for charge and payment entry within Electronic Health Record. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/ claim adjudication;
· Responsible for correcting, completing, and processing claims for all payer codes;
· Analyze and interpret that claim are accurately sent to insurance companies;
· Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial
· insurance companies on unpaid insurance accounts identified through aging reports;
· Process appeals online or via paper submission;
· Assist in reconciling deposit and patient collections;
· Assist with billing audit related information;
· Process refund requests;
· Communicate with billing and credentialing coordinator to identify and resolve audit review issues;
· Process billing calls and questions from patients and third - party carriers;
· Answer/respond to correspondence related to patient accounts. Is available to answer billing and changes related inquiries by patients, staffs, Managed Care Organization
· Communicate daily with internal and external customers via phone calls and written communications;
· Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Team Lead and/or Supervisor;
· Research, record findings, and communicates effectively with Manager to achieve optimum performance;
· Pursue and participate in education to remain current with changes in the Healthcare industry;
· Maintain patient confidence and protects medical office operations by keeping patient information confidential;
· Contribute to team effort by accomplishing related results as needed;
· Promote effective working relations and work effectively as part of a team to facilitate the department’s ability to meet its goals and objectives;
· Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to insure a professional, responsible and courteous environment;
· Perform other duties as assigned to support Excel’s Mission, Vision, and Values.
QUALIFICATIONS:
· Minimum of 2+ years’ experience of related experience in a business, medical or technical environment.
· Experience working with Medicare / Medicaid / Managed Care claims
· Knowledge of healthcare regulations and guidelines including;
o CMS
o DMHC
o DHCS guidelines
· High School Diploma or GED required.
· Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms and CPT Coding.
· Intermediate skill levels in Microsoft Word, Excel, and Outlook preferred.
· Ability to speak effectively before groups of customers or employees of the organization.
· Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra.
· Ability to apply common sense understanding to carry out instructions furnished in written, oral, and diagram form.
· Ability to deal with problems involving several concrete variables in standardized situations.
· Detail oriented
· Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
· Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.
· Previous experience in a medical office setting and/or experience with an Electronic Medical Record a plus
· Customer service driven;
· Understanding of medical terminology and insurance laws/guidelines;
TECHNICAL REQUIREMENTS
· Knowledge and experience with Microsoft Word, and Outlook software.
· Must be willing to learn applicable computer programs.
BEHAVIORAL REQUIREMENTS
· Demonstrate accountability for one’s own actions.
· Complete routine and priority tasks within departmental time frames.
· Convey care when answering phone calls and assisting customers.
· Demonstrate the ability to effectively interact with both external and internal customers in difficult situations.
· Demonstrate ability to make sound decisions.
· Demonstrate accountability for one’s own actions.
· Complete routine and priority tasks within departmental time frames.
· Convey care when answering phone calls and assisting customers.
· Maintain confidentially when handling sensitive material.
LANGUAGE SKILLS
· Proficiency in speaking, reading, and writing English is required. Speaking Spanish, Vietnamese, Chinese and/or Tagalog is desirable but not required.
PHYSICAL DEMANDS
· The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
· While performing the duties of this position, the employee is regularly required to sit, possibly 90% of the workday, stand infrequently, use a computer keyboard frequently and intermittently throughout the day, and use hands to finger, handle, or feel objects, tools or controls. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to walk.
· The employee must be able to infrequently lift and move up to 25 pounds. Specific vision abilities required by this position include close vision, color vision and the ability to adjust focus.
· Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
Education: High School
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