II. POSITION SUMMARY:

Under the general supervision of the Business Office Manger, the Collections specialist monitors and organizes in-patient and outpatient claims for electronic or hard copy billing to appropriate payers. Reviews claims to make sure that payer specific billing requirements are met. Follows up on billing, denials, appeals and aged accounts receivable. Determines and requests appropriate adjustments, answers inquiries and updates accounts as necessary. Familiar with standard concepts, practices, and procedures within a healthcare setting. Knowledge of ICD-10 and CPT codes. Knowledge of payment posting of insurance and patient payments. Performs a variety of tasks and other projects as assigned by the Business Office Manager. 

III. ESSENTIAL FUNCTIONS:

• Responsible for accurate and timely billing, either manually or electronically to appropriate third party payer. Transmits claims as assigned daily. Audits system for incomplete claims.

• Screens and distributes incoming correspondence, distribution and filing of mail. Maintains appropriate files, and organizes filing systems required for maintenance of billing records and reports.

•  Handles incoming telephone calls in a professional manner. Prepares required reports, records, and schedules with a high degree of accuracy. 

• Maintains running current logs of billed claims, denials, appeals, and claims requiring additional information. Manages patient accounts to achieve AR goal. 

• Utilizes specialized knowledge of insurance systems for completion of all required billing forms for assigned pay classes.

• Obtains additional information where applicable and updates information to the appropriate account.

•  Verify that all insurance payments are paid as contracted.

• Provides assistance to the Business Office Manager in the preparation and distribution of correspondence. Performs other duties as assigned by Business Office Manger.

IV. EDUCATION/EXPERIENCE REQUIREMENTS:

• High school graduate or equivalent
• Certificate in Medical Billing and Coding 
• A minimum of 2 years healthcare billing experience, preferably in a hospital setting. Proficient in using word processing, excel, Billing Software, and be familiar with Electronic Health Records.  

V. PHYSICAL DEMANDS

1. Physical Activity - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

1. Working Hazards or Risks – potential for musculoskeletal injuries related to moving and working with files and office equipment.

1. OSHA Blood Borne Risk Category III.