Billing Specialist

Job Description

Billing Specialist

InterCommunity, Inc. is a growing, progressive, non-profit community health center with over 40 years of experience in the community.  We’ve been the grateful recipient over the past several years of numerous local and national awards for the innovative services we provide, and have just been named a Hartford Courant/Fox CT Top Small Workplace Award winner for the EIGHTH consecutive year!

Services will be entered by the Billing Specialist, but all checks will be done in the AR department. Additionally, follow up of unpaid client accounts and general filing and other office duties will be needed.

• Researches any overdue account balance that is fully or partially unpaid and follows up by mail and/or phone to insurance carriers or customers on delinquent payments.
• Reviews claims denied for payment and underpaid claims. Responds to customer inquiries regarding account status. Researches customer’s accounts thoroughly and documents appropriately.
• Resolves discrepancies and prepares adjustments and refunds as necessary.
• Brings recurring issues to the attention of the department supervisor.
• Initiates bills and resubmits bills as necessary.
• Pursues patient for payment obligations when insurance defaults as permitted by law or contractual relationships. Receives and processes payments and denial of payments. Separates payments into batches.
• Posts payments to accounts according to the service dates to ensure accurate payment status and accurate account activity. Prepares completed cash batches for filing.
• Prepares and posts adjustment to appropriate accounts as necessary.
• Processes refunds immediately to the government if overpayments have occurred.
• Demonstrates professional etiquette and courtesy when interfacing with customers.  Resolves patient/customer complaints by identifying problems and coordinating appropriate corrective action.
• Performs timely follow-up on initial and renewal authorizations to maintain reimbursement activity.
• Ensures that payor changes are completed accurately, payment is guaranteed and revenue is recorded appropriately.
• Verifies that the correct payor is tied to the service/therapy and ensures that the correct allowable is recorded in accordance with the contract. Contacts payor /insurers to verify insurance coverage and eligibility requirement of patients that are changing payors.
• Obtain verbal /written authorization for medical treatment from appropriate sources.
• Verifies insurance information for accuracy and completeness and resolves discrepancies as necessary. Documents all account activity in system.
• Perform internal quality audits to ensure that all necessary documentation is included in each patient file.
• Requests adjustments on accounts and recommends necessary changes to supervisor.
• Performs other related duties as required.

Knowledge of claim/billing process. Knowledge of various insurance plans, entitlement programs and their claim procedures; Ability to effectively use the computerized billing program; ability to communicate effectively with co-workers, clients, and external parties to resolve claim problems and obtain collections; problem solving skills; research skills; ability to work independently; ability to learn and apply technological tools. considerable interpersonal skills. Demonstrate flexible and efficient time management; prioritize workload

Associates degree or equivalent from two-year college or technical school; two (2) years related experience and/or training; or equivalent combination of education and experience; two (2) years EPIC program experience