Billing Specialist

REPORTS TO: Director of Billing Services EDUCATION: High School Diploma or Equivalent required, College Hours preferred SKILLS: Computer literacy, knowledge of ICD-10 CM/CPT coding, medical office billing and collection practices, federal/state/local financial assistance programs, strong interpersonal, oral, and written communication skills, excellent telephone, and customer service skills.

PHYSICAL AND MENTAL REQUIREMENTS: See reverse

PRIMARY DUTIES • Maintain a current knowledge of insurance carrier and/or state program claims filing policies and procedures • Verify patient demographics and financial coverage; update as needed • Research and verify patient and/or insurance company and/or state program refunds/recoupments • Adjust patients accounts to reflect changes in payment responsibility • Verify accuracy of information on paper medical claim forms and mail to selected insurance carriers and/or state programs • Research patient charges not automatically assigned to selected insurance carriers and/or state programs, make corrections and assign manually • Maintain patient accounts; give GHC program discounts and/or other adjustments as needed • Appeal service charges rejected by selected insurance carriers and/or state programs and resubmit amended claim forms • Process claims/vouchers as needed for insurance plans and/or state programs • Obtain pre-certifications, prior-authorizations, or referrals for special provider services as needed • Verify motor vehicle or accident information with patient’s insurance carrier • Maintain work ques with claim errors • Assist insurance carriers and/or state programs to acquire supplemental patient information needed to process claims • Assist patients to understand fees for services and billing processes • Assist patients to make payment arrangements and find financial assistance • Assist outside providers and vendors to obtain physician billing information • Assist employees to understand policies and procedures related to billing matters • Communicate and support training issues with billing staff • Comply with all regulations related to confidentiality of patient information • Maintain and/or create new payor and plans as needed • Able to manage multiple priorities and manage stress appropriately • Communicates appropriately and clearly with a pleasant and professional manner to all • Demonstrates excellent judgment in handling situations not covered by written or verbal instructions • Demonstrates a commitment to the mission, core values, and goals of Waco Family Medicine and its healthcare delivery including the ability to deliver exceptional patient focus with quality, compassion, and respect • Maintain certifications and website passwords as applicable

OTHER DUTIES • Assist in scheduling patient appointments • Process billing statements and balance notification letters to patients • Assist patients to make payments on owed balances • Provide follow-up on patient’s payment arrangements • Assist with daily mail duties • Provide backup support for clerks and other billing staff as needed • Other duties as assigned by supervisor

PHYSICAL AND MENTAL REQUIREMENTS: • Visual and auditory accuracy • Shift length – 8 hours • Indoor setting • Continuous use of computer, calculator • Long periods of sitting and walking • Frequent use of telephone • Frequent use of stepladder • Continuous repetitive grasping and manipulation of both hands • Continuous conversational communication • Occasional reaching, standing, squatting, bending, kneeling, twisting and climbing • Occasional carrying, lifting, pushing and pulling of up to 10 Lbs • Infrequent use of personal transportation • Working in a frequently noise environment • Continuously working in a tight area • Understand/carry out simple/detailed, oral/written instructions • Memorize and retain instructions • Read and interpret detailed specifications.