Job Description

JOB SUMMARY:
The Revenue Cycle Account Billing Specialist manages the accounts receivable in accordance with compliance regulatory and billing guidelines and specific payer rules. Responsible for the accurate billing of insurance claims by validating coverage and resolving charge review edits, claim edits and front end clearinghouse and payer rejections. Responsible for verifying accuracy of all billing requirements that are obtained in order to confirm work orders, obtain prior authorizations, process and post self-pay payments, submit claims and identify and resolve billing errors. Responsible for creating and uploading statement files, as well as working any incorrect address rejections. In addition, prepares accounts for bad debt. Accountable for Carle Financial Assistance Program (CFAP) set up and review of account and adjustment requests. Other duties include follow up on outstanding receivables through activities such as basic appeals, answering, documenting and completing inquiries from patients, insurance companies, public agencies, internal departments and 3rd party payers.

EDUCATIONAL REQUIREMENTS
Associates degree preferred

CERTIFICATION & LICENSURE REQUIREMENTS
None specified.

EXPERIENCE REQUIREMENTS
One-year customer service experience in health care preferred. General computer knowledge related to Microsoft Office applications such as Word, Excel and Outlook. Proficient in the use of office based technology i.e. computer, copier, fax, scanner, etc.

SKILLS AND KNOWLEDGE
Strong written and oral communication skills; displays a high standard of confidentiality; ability to deal with a large volume of work and the ability to multitask. Maintain a comprehensive working knowledge of assigned payer billing policies and guidelines. Work proficiently within revenue cycle billing systems; attention for details; ability to prioritize and complete tasks under demanding conditions; ability to easily accept and implement change.

ESSENTIAL FUNCTIONS:

• Identifies and resolves insurance set up errors to facilitate accurate and timely billing and payment processing.
• Resolves charge review edits, claim edits and clearinghouse and payer rejections to facilitate accurate billing and payment processing.
• Submits claims for assigned payers, including corrected and voided claims.
• Works accounts receivable work queues or task lists to perform collection activities such as following up on outstanding receivables; contacting patients, payers, attorneys or employers via phone, website/web portal or mail.
• Reviews and resolves incoming correspondence for outstanding accounts receivable.
• Resolves underpayments, no payments, overpayments and undistributed payments for proper allocation.
• Identifies, prepares and requests adjustments.
• Identifies bad debt accounts and prepares information for the collection agency as necessary.
• Answers phones to complete inquiries from patients, attorneys, insurance companies, public agencies, internal departments and 3rd party payers.
• Prepares, completes and follows up on designated payer reports and forms.
• Establishes payment arrangements and applies self-pay payments.
• Reviews, processes and requests prior and subsequent authorizations based on payer guidelines on an as needed basis.
• Reviews, processes and confirms all work orders to ensure accuracy.
• Creates, uploads and processes files for self-pay statements and payment arrangements.
• Responsible for Community Care Financial Assistance Program set up, review of accounts and adjustment requests.
• Responsible for Prompt Pay Discount review and adjustment requests.

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