Biller / Collector

Cibola General Hospital

0-2 years

Not Disclosed

Remote, USA

10 Nov. 25, 2024

Job Description

Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Summary:
The Patient Financial Services Billing and Collections Specialist is responsible for managing billing and collections for various insurance types, including Medicare, Medicaid, Commercial Insurance, government agencies, and third-party liability claims. This role ensures timely resolution of unpaid balances, facilitates financial arrangements for patients, and handles financial assistance for qualified patients through outside agencies.

Primary Functions:

Maintain and audit accounts receivables/credits over 45 days old, documenting notes for productivity.
Work on an average of 30 accounts per day (150 accounts per week).
Communicate with billing staff to improve primary and secondary claim billing processes.
Review insurance EOBs (Explanation of Benefits) for potential processing errors.
Respond to denials and correspondence within a two-day timeframe.
Ensure accurate allocation of balances between insurance and patients.
Assist patients with billing inquiries, both over the phone and in person.
Address audits and regulatory inquiries in a timely manner.
Research and resolve credit balances for assigned insurances.
Educate staff on assigned payers and serve as the representative for specific payers.
Collaborate with other departments for prompt billing corrections.
Perform other duties as assigned.

Education and Experience:

High school diploma or GED required.
1-3 years of data entry, billing, and claims experience in a healthcare setting or billing externship. Education or knowledge may be substituted for experience.
Experience in a multispecialty clinic setting preferred.

Preferred Certifications:

Billing Certificate from a certified billing school.
Coder and/or Billing Certificate may substitute for knowledge of healthcare billing processes.

Knowledge, Skills, and Abilities:

Familiarity with computerized practice management systems (Cerner Electronic Health Record System preferred).
Ability to learn billing and collection systems in rural health facilities and critical access hospitals.
Strong communication skills, with tact and diplomacy when interacting with diverse groups including staff, providers, and insurance companies.
Sensitivity to the patient population being served.
Strong attention to detail and ability to work independently with minimal supervision.
Proficiency in computers and MS Windows software programs.
Knowledge of HIPAA compliance and medical/behavioral health billing.
Familiarity with UB04, HCFA1500 claim forms (both electronic and paper).
Knowledge of Federally Qualified Health Care billing and reimbursement preferred.
Understanding of Medicare and Medicaid guidelines.

Additional Qualifications:

Bilingual (English/Spanish) preferred.
Healthcare experience highly preferred.

Reporting:
Reports to the PFS Director.

Physical Requirements:

Ability to sit, stand, or walk for extended periods.
Ability to view a computer screen for long durations.
Ability to perform repetitive hand and wrist motions for extended periods.

Hybrid Work Status:
This position requires a minimum of three days in-office per week after completing proper training and with the discretion of the Patient Financial Services Director based on independent work capability.

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