Overview
Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution.
Special Instructions
Position is On-Site with Hybrid work option after at least six months
Responsibilities
- Promote the mission, vision, and values of the organization
- Import charges from queues in a timely manner and append modifiers or any required information for claim transmission
- Review daily accounts that are ready to be billed in Waystar from Meditech
- Initiate correction on all claims with errors by the designated time
- Follow up on any correspondence that may have been received on that day or the previous day
- Cross train on billing all lines of business to the different payers
- Pull listing of all accounts assigned to be follow up by specific payer
- Diagnostic and procedural coding
- Follow-Up Responsibilities
- Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
- Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.
- Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts.
- Maintain accounts receivable detail of their accounts through tasking.
- Maintains standards per payer for percentage accounts >90 days.
- Works minimum standard number of accounts per payer per day.
- Meets or exceeds collection goals by payer each month.
- Works all assigned accounts as assigned, depending on balance.
- Complete appeals as required.
- Participates in educational activities and attends monthly department staff meetings.
- Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
- Other duties as assigned from time to time.
- Attend educational activities and monthly department staff meetings
- Perform other duties as assigned
Qualifications
Required Education
- High School Diploma or GED required.
Preferred Experience
- Six (6) months of previous experience in clinic registration, billing and collections, financial counseling, or customer service preferred.
Required Skills, Knowledge, and Abilities
- Basic computer proficiency.
- Typing speed of at least 40 words per minute (WPM).
- Good written and verbal communication skills for effective account follow-up.
Preferred Skills, Knowledge, and Abilities
- Knowledge of medical terminology preferred.
- Familiarity with CPT and ICD-9 coding preferred.
