Billing Specialist

Overview : SCOPE :

SCOPE :

Under general supervision is responsible for all claim submissions, which includes verifying accuracy of charges and patient demographic information on claim detail.

Responsible for timely follow-up with patients and third party payors. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards

ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Collects and reviews all patient insurance information needed to complete the billing process.
• Completes all necessary insurance forms (i.e. HCFA 1500, Blue Cross / Blue Shield, UMWA, Medical Assistance, Medicare, etc.

to process the proper billing information in a timely manner as required by all third party payors.

• Transmits daily all electronic claims to third party payors. Researches and resolves any electronic claim delays within 24 hours of exception report print date.
• Submits all paper claims and supporting documentation as required by payors. Files all claims, documentation, etc. in patient financial files.
• Resolves patient complaints and requests regarding insurance billing and initiates accurate account adjustment. Follows all billing problems to conclusion.
• Resubmits insurance claims as required. Reports any trends / delays to supervisor.
• Processes any necessary insurance / patient correspondence. Mails accurate statements to patients within 24 hours of print date.
• Provides all necessary documentation (on or with HCFA1500) required to expedite payments. This includes demographic, authorization / referrals, UPIN number, and referring doctors.

Submits claims within 24 hours of print date.

• Obtains appropriate medical records with patient and / or responsible party authorization on file as they relate to the billing process.
• Maintains confidentiality in regards to patient account status and the financial affairs of clinic / corporation. Communicates effectively to payors and / or claims clearinghouse to ensure accurate and timely electronically filed claims.

MINIMUM QUALIFICATIONS :

High school graduate or equivalent. Minimum three years experience in a medical business office setting.

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.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work may require sitting for long periods of time;

also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds.

Requires manual dexterity sufficient to operate a keyboard, a calculator, telephone, copier and other such office equipment.

Vision must be correctable to 20 / 20 and hearing must be in the normal range for telephone contacts. It is necessary to view and type on computer screens for prolonged periods of time.

WORK ENVIRONMENT :

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment.

Involves frequent interaction with staff, patients and the public.