Billing & Collections/Charge Entry and Reimbursement Specialist

BILLING AND COLLECTIONS DUTIES:

• Sending out monthly statements/invoices.
• Sending collection letters to patients that are delinquent on their bills and follow-up
• Responsible for setting up payment plans for accounts in arrears
• Answer questions for billing inquiries and insurance payment inquiries, by phone, in person and written.
• Sending account information to collection agency
• Reinstate bad debt accounts and apply payments
• Post pay directs towards collection accounts and notify agency
• Send patients account information for taxes, flex accounts and itemize print outs.
• NSF follow ups
• Insurance verification and clearances for elective procedures and prior payments arrangements for non-covered items (i.e. vasectomy, IUD’s, implantable devices, etc.)
• Print out attorney requests for court action (i.e. work comp, liability suits)
• Put alert on Bankruptcy accounts
• Create invoices as necessary
• Responsible for updating Business Office of changed Billing & Collection policies and procedures.
• Post personal payments, (cash, checks, money orders & credit cards)
• Set up accounts for drug screens.
• Balance front office staff bank pouches
• Monitor credit card terminals, update staff on any changes.
• Run and balance to credit card end of day reconciliation report
• Monitor overpayments and handle appropriately
• Post refunds and mail checks
• Post adjustments, split provider adjustments, collection write offs, small balances, provider reductions, etc.
• Monitor insurance contracts and follow up on any discrepancies
• Update file maintenance – dx codes, CPT codes, providers, NPI numbers, etc.
• Post INR home charges
• Post NextMD payments and reconcile to InstaMed end of day balance
• Post HRA payments.
• Move patients to own account when they turn 18
• Follow the unapplied list and apply to encounters as appropriate
• Monitor postal meter and download postage updates when applicable
• Import and post Medicaid ERA’s, work denials, enter electronic secondary claims into Forward Health Portal, etc.
• Import and post Unity/Medicaid Unity ERA
• Work and follow up on late list for assigned task groups, Medicaid and Medicaid Unity.
• Monitor Unity capitation
• Follow up on insurance pending route slips
• Run Billing & Collection Reports (i.e. first OB, unity cap, estate accts, employer

accts, etc)

• Manage and update claim edit library
• Manage and set up work log tasks
• Set up payers to receive electronic remittance advices
• Assist in EPM technical issues and provider support to staff, open support ticket when needed.
• Process auto credit card payments per patient’s request
• Complete & fax Child Support Agency & Housing forms
• Monitor & clean up alerts

ADITIONAL FUNCTIONS:

• Handles pop and postage money
• Order coffee and stock in break room as needed
• Deliver bank deposits as needed
• Take certified mail to post office as needed
• Assists in running outgoing mail thru postage meter
• Assists in sorting incoming mail
• Assists in running claims when Insurance Specialist is out
• Assists in posting charges when Charge Entry person is out
• Assists in manual updates of new fees into File Maintenance in EPM that don’t upload
• Assist in working unbilled charge report
• Assist in posting/scanning commercial remittance advices
• Assist in importing and posting ERA checks
• Assist in working aging tasks
• Other duties as assigned
• Assists other departments as needed
• Attends training sessions as requested and/or desired for knowledge and expertise with position

CHARGE ENTRY DUTIES:

• Posts in-house charges, which have been reviewed by the Coding Department to patient’s accounts using CPT 4 and ICD 9 codes. Reviews coding rules and specific payer guidelines when posting.
• Run claim edit when posting charge, refer to appropriate Department to correct.
• Apply unapplied payments when applicable.
• Work immunization reconciliation report.
• Post flu shots
• Code allergy shot route slips
• Create encounters and post charges for Home Health certification and recertification paperwork.
• Work unapplied report
• Monitoring & notifying coding department when unbilled claim is approaching timely filing limit.
• Manage charges in holding tank, accept & decline when appropriate.
• Post flu vaccine charges from flu shot form.

ADDITIONAL FUNCTIONS:

• Assist in following up on unbilled list
• Assist in creating encounters and posting nursing home visits.
• Other duties as assigned
• Assists in working Billing and Collection reports as needed
• Assists other departments as needed
• Attends training sessions as requested and/or desired for knowledge and expertise with position
• Assists in monitoring old alerts and refers to appropriate department.

REIMBURSEMENT SPECIALIST:

• Posts payments from commercial and contracted insurances, verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles. Scanning and attaching Explanation of Benefits to corresponding encounter.
• Posts Quic Remit credit card payments and scans Explanation of Benefits.
• Imports and posts Electronic Remittance Advices. Verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles.
• Posts EFT payments from commercial insurances verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles. Scanning and attaching Explanation of Benefits to corresponding encounter. Create dummy deposit slip for balancing.
• Imports and posts Medicare Electronic Remittance Advices. Verifying correct account, patient, payment amount, adjustment, co-pay, co-ins, and deductibles. Create dummy deposit slip for balancing as Medicare funds are electronically transferred.
• Refers denied or incorrectly paid claims to Insurance specialist for follow up.
• Makes copies of EOB’s for departments where follow up is necessary, i.e. overpayments, denials, secondary insurance, etc.
• Post HRA payments.
• Work aging task list for Unity, Unity Medicaid and Physicians Plus, primary and secondary, referring to appropriate department for follow up when needed.
• Work aging task list for workers compensation and liability visits. Calling insurance companies to follow up when appropriate.
• Force bill electronic COB claims to secondary payers.
• File denied workers comp and liability claims to health insurance if applicable.

ADDITIONAL FUNCTIONS:

• Assists with insurance verification and clearances for elective procedures and prior payments arrangements for non covered items (i.e. vasectomy, IUD’s, implantable devices, etc.)
• Assists with printing out attorney requests for court action (i.e. work comp, liability suits)
• Other duties as assigned
• Assists other departments as needed
• Attends training sessions as requested and/or desired for knowledge and expertise with position
• Assist in posting personal payments, verifying correct account and amount.
• Assist in posting insurance credit card payments and scan EOB

SKILLS AND ABILITIES:

• Exercises independent judgment and initiative.
• Must be able to Multi-task.
• Maintains a professional, courteous demeanor when dealing with providers, other employees, the general public and other outside agencies.
• Maintains patient confidence and protects operations by keeping all information confidential. Abides by all HIPAA regulations.
• Good interpersonal and organizational skills.
• Maintains regular consistent and professional attendance, punctuality, personal appearance and adherence to relevant health and safety procedures.
• Entry level computer and keyboarding skills

Job Type: Full-time

Pay: $19.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• Clinic
• Medical office

Experience:

• Charge Entry: 1 year (Preferred)

Ability to Relocate:

• Sauk City, WI 53583: Relocate before starting work (Required)

Work Location: In person

Apply at https://www.prairieclinic.com/careers