Billing specialist

Billing Specialist

Job Summary :

The Billing Specialist has responsibility for third-party claims and collections process for clients / patients. Primary responsibilities include timely claim generation, sending follow up correspondence with payors, patient invoicing, collections, and reporting.

Supervisory Responsibilities :

None

Duties & Responsibilities :

• Prepares and submits clean claims daily to third party payers using billing software
• Coordinates with team members to ensure prior authorizations have been obtained and credentialing requirements have been met prior to billing
• Audits data to identify discrepancies that could lead to denials or underpayments
• Tracks, manages, and reports on overall revenue cycle management (RCM) process to ensure timely payments
• Reviews and submits client invoices, work with clients' families to address any questions regarding client responsibility;

escalates concerns to leadership as needed

• Sets up patient payment plans and works A / R outstanding collection accounts
• Identifies and works client coordination of benefits issues with multi-payers per client as they arise
• Identifies, resolves, and settles outstanding balances on denials / underpayment / overpayments
• Interprets electronic remittance advice (ERAs), post payments, and own financial data integrity for clients / patients
• Answers patient or insurance telephone / email inquiries
• Maintains weekly and monthly dashboards / reports
• Collaborates with RCM team on process / workflow improvement
• Remains current on payor-specific billing / coding guidelines and collaborates with operations and clinical teams to implement changes, as needed
• Adheres to HIPAA guidelines and regulations
• Maintains productivity and quality standards as determined by the department
• Performs all other duties as assigned

Required Education, Certifications, Skills & Abilities :

• Bachelor's degree (preferred)
• 2 years of medical billing / collections experience
• Excellent problem-solving skills
• Excellent organizational skills

Additional Requirements :

• Must have a valid driver's license
• Must be willing to work at different SMF locations if requested
• Maintains confidentiality and privacy in accordance with HIPAA and SMF policies
• Understands and adheres to SMF Compliance Standards, Code of Conduct and Conflict of Interest policy
• Exhibits professional conduct at all times
• Ability to set priorities and manage time effectively to meet deadlines; work independently and cooperatively in a multicultural, multilingual environment;

work flexible hours; effectively interact with community agencies, patients, and clinical personnel.

Training Requirements :

The Billing Specialist, in conjunction with other staff, will be responsible for attending all mandatory training that appropriately matches the skill set and position they are performing.

Physical Requirements :

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions)

• Ability to sit for long periods of time
• Constantly operates a computer and other office productivity machinery, such as calculator, copy machine, and computer printer
• Ability to physically write and visually read

Sandhills Medical Foundation, Inc. has been providing quality, comprehensive health care since 1977. We are a Federally Qualified Health Center (FQHC) serving residents of Chesterfield, Kershaw, Lancaster, and Sumter counties.

The mission of Sandhills Medical Foundation, Inc. is to be responsive to community healthcare needs by providing quality, comprehensive, and cost effective healthcare.

• 401k
• 401k matching
• Health Insurance
• Dental Insurance
• Life Insurance
• Vision Insurance
• PTO and Sick Leave
• Employee EAP Program

Last updated : 2024-09-25