The Billing/Collections Specialist contributes to the financial viability of the organization by assuring that accounts have been properly billed and reimbursed. Responsibilities include contacting the appropriate insurance company to secure and expedite payments through the follow-up and appeals resolution processes and acting as a functional leader or reference source. This position required discretion and good judgement in decision-making and representation of the Hospital. Work situations are varied and require extensive insurance billing, follow-up and appeal knowledge, and strong customer service skills. This position provides the link in communication between Hospital and the patient, insurance companies/third party payers and the provider of service or departmental staff. The Insurance follow-up specialist performs these functions at a complex level of implementation, analysis and resolution.
Job Duties:
Reviews and evaluates outstanding and/or denied accounts, expediting resolution and assuring a current statusContacts insurance company/third party to collect outstanding payments. Researches unpaid/denied claims through phone contact and/or payer websites to determine if claim needs to be rebilled or if in process. Reschedules follow-up activity if confirmation of payment is not obtained.Researches and appeals denied claims from third party payer, determining steps that need to be taken for the purpose of securing payment, including but not limited to interacting with department personnel and third party payers in the denial process. Handles situations that require research or adaptation of response in order to solve a problem account.Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claimContacts insurance company/third parties, patients, physicians, and/or departmental staff to obtain necessary or missing information.Escalates any issues or concerns regarding individual insurance companies, including problem accounts when appropriate intervention is required.Demonstrates and maintains knowledge of payors billing and reimbursement policies and procedures and complies with such regulations.