Billing Specialist

The Billing Specialist posts payments received from insurance companies, cash payments and payment plans to patient’s accounts; enters adjustments, write offs and reconciles patient’s accounts. The Billing Specialist reviews claims for non- payment, posts the zero payment to the patient’s account and writes off the unpaid procedures and claims; resubmits claims with corrected codes, submits secondary claims and mails statements for co-pays and balances due on the account. The Billing Specialist works reports; processes refunds and check requests; does account clean up, and serves as a resource to the dental practices to help improve billing processes and accuracy.


QUALIFICATIONS
Experience: A minimum of six (6) months experience in a health care collections or related field, or any combination of education, training, or experience in a health care business office environment. Experience with insurance billing, computer and business software programs preferred.

Additional Requirements: May be required to work flexible hours and occasional overtime.

PRIMARY RESPONSIBILITIES

THE ESSENTIAL JOB FUNCTIONS OF THE POSITION


1. Post Cash payments, primary & secondary insurance payments and Payment Plans


2. Secondary Insurance Payment


3. Post Zero Pays


4. Write-off unpaid claims


5. Resubmit claims with corrected codes


6. Mail Secondary Claims


7. Mail Statements for Co-pays and Patient Balances


8. Clean-up accounts


9. Process Insurance Refund Requests for overpayment


10. Process Check Refund Requests from Patients


11. Work Reports


12. Assists dental offices with any patient / insurance payment questions


13. Achieve departmental goals for accurately submitting both paper and electronic insurance claims for previous day’s treatment


Upgrade to see actual infotermine if claims need to be submitted electronically or via paper and send all supporting documentation


15. Correct and send rejected claims


16. Contact dental offices for information necessary to send a claim


17. Assists dental offices with claim submission questions


18. Verify all demographic (spelling of names, date of birth, and insurance carrier) information is correct.


19. Correct insurance and demographic information if incorrect and resubmit a corrected claim within 95 days from DOS.


20. Work weekly reports


21. Adheres to company, department, corporate, personnel and standard policies and procedures.


22. Attend all mandatory company in-services and staff development activities as scheduled.


23. Adhere to company standards concerning conduct, dress, attendance and punctuality.


24. Support company-wide quality/performance improvement goals and objectives.


25. Maintain confidentiality of company employees and patient information.


26. Perform other duties as assigned


Note: The essential job functions of this position are not limited to the duties listed above.


KNOWLEDGE, SKILLS, AND MENTAL APTITUDE


THIS SECTION DESCRIBES WHAT KNOWLEDGE, SKILLS AND ABILITIES AN EMPLOYEE IN THIS POSITION SHOULD CURRENTLY POSSESS. THIS LIST MAY NOT BE COMPLETE FOR ALL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED FOR THIS POSITION.


1. Knowledge of coding and billing procedures.


2. Knowledge of computer software applications.


3. Knowledge of insurance billing and collection procedures.


4. Skill in organizing and prioritizing workloads to meet deadlines.


5. Skill in telephone etiquette.


6. Effective oral and written communication skills.


7. Ability to communicate effectively with patients and co-workers.


8. Ability to adhere to safety policies and procedures.


9. Ability to use good judgement and to maintain confidentiality of information.


10. Ability to work as a team player.


11. Ability to demonstrate tact, resourcefulness, patience and dedication.


12. Ability to accept direction and adhere to policies and procedures.


13. Ability to work in a fast-paced environment.


14. Ability to react calmly and effectively in emergency situations.


15. Ability to meet corporate Upgrade to see actual infoYSICAL, MENTAL, AND SPECIAL DEMANDS


THIS SECTION DESCRIBES HOW AN EMPLOYEE IN THIS POSITION CURRENTLY PERFORMS THE FUNCTIONS OF THIS POSITION. MODIFICATIONS TO THE MANNER IN WHICH THIS JOB MAY BE PERFORMED WILL BE REVIEWED ON A CASE BY CASE BASIS.


1. Ability to work a 40 hour week.


2. Ability to sit for long periods, up to 8 hours.


3. Ability to use both hands in fine manipulation of small tools (copier, computer, telephone,

typewriter, calculator, safe, facsimile machine).


4. Ability to push and pull up to 10 lbs. (file cabinet drawers, computer paper boxes).


5. Ability to see well enough to read handwritten and typewritten material.


6. Ability to lift and carry up to 25 pounds to move file boxes and data processing paper.


7. Ability to retrieve files from bottom shelves and drawers and move boxes of paper and forms to

the computer printer.


8. Ability to reach, turn and twist above and below the waist daily to retrieve files.


9. Ability to spend 90% working time in an environment of continuous low voices and office

machine noise typical for business office atmosphere.


10. Ability to handle a variety of repetitive tasks.


MACHINES, TOOLS, EQUIPMENT, AND OTHER WORK AIDES


THIS SECTION DESCRIBES THOSE MACHINES, TOOLS, EQUIPMENT AND OTHER WORK AIDES AN EMPLOYEE IN THIS POSITION MUST BE ABLE TO USE.


1. Telephone


2. Copy machine


3. Computer and various software packages


4. Calculator/10-Key


5. Facsimile machine


6. Postage meter


7. Policies and procedure manuals