BILLING SPECIALIST- FULL TIME

Job DetailsJob Location: Sweeny, TX 77480Position Type: Full TimeJob Shift: DaySummary/Objective: The Clinic – Billing Specialist performs a wide variety of billing duties which include patient &/or third-party billing, account oversight, payments/adjustments processing, insurance follow up, and other routine tasks assigned.  Responsible for the billing and collection of payments for all Sweeny Community Hospital outpatient clinics and the Rural Health Clinic.    Essential Functions following established practices or Policy & Procedures: Manages patient &/or third-party billing, routinely on an established group of payers. Duties include, but not limited to claims/statement processing, payments/adjustments/refunds activities, denial management, & follow-up.  Promptly addresses patient questions/concerns related to their claim/statement.  Assists & facilitates patient/guarantor with self-pay payment options (employee deduction [per HR P&P] / electronic auto-draft pay plans via current credit card processing system). Manage over 60 days claims try to capture payment from insurance/patients. Must stay current on all payer/Medicare/Medicaid billing requirements which may include attending seminars or other professional development activities. Maintain high level of accuracy and assure compliant billing of claims. Communicates payer trends impacting revenue to supervisor. Must stay current on all RHC billing requirements which may include attending seminars or other professional development activities and communicate rules impacting revenue to supervisor. Account Collection and Follow up: Works all claims in assigned payer category utilizing health information system automated functions and industry standard collection practices. Ensures accounts in worklist are reviewed daily and appropriate action taken to ensure claim is accurately billed in accordance with established procedures; payment is received in a timely manner and correct payment for services is received. Performs account research as needed for account resolution by contacting third party payers, clinics, patients/parents, or other resources. Analyzes and processes account information to bring resolution to open accounts in accordance with established procedures. Performs data entry into HIS system for any collection efforts on accounts such as revision to insurance carrier, changes in financial class, payer transfers, and documentation on actions taken for account resolution and refers account to bad debt in accordance with established procedures. Places account on work list as needed for future follow up and completes daily list of accounts averaging 80% of all accounts reviewed and/or resolved over a 30-day period. Utilizes local payer portals and/or RTE system for account/claim status and follow up. Processes revised and corrected claims with the appropriate insurance adjustment forms or billing method in accordance with established procedure. Adjustments to patient accounts including adjustments to payments, contractual allowances, charges, etc. will be completed in accordance with established procedures. Accounts will be processed for self-pay collection as appropriate in accordance with established procedures. Reviews all aged accounts giving priority to accounts based on dollar value and/or aging timeframe. QualificationsOther Duties: Assists Billing Office team as needed Assists Registration team when needed for financial questions regarding patient’s accounts Assists Manager and CFO as requested for special reports &/or projects.   Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job.   Required Education, Experience and License: Valid Texas Driver License with an acceptable record Basic knowledge of medical provider/facility billing and insurance practices Two years experience in a healthcare-related field   Preferred Education, Experience and License (Billing Specialist II/after minimum 6 months w/ SCH): Two years healthcare billing experience Knowledge of Medical terminology Knowledge of CPT/HCPCS revenue codes Certification in Billing/Coding College course work in accounting, business, or Healthcare Administration Associates degree from accredited College/University   Additional Eligibility Qualifications: Able to manage multiple duties effectively Excellent customer service Excellent organizational skills Basic Microsoft Office applications Manage strict deadlines with success. Excellent verbal and communication skills Detail/number oriented, accurate keyboarding skills Able to appropriately handle stressful situations and difficult people Self-motivated, a self-starter, and self –directed to manage areas of responsibility   Competencies: Ethical Conduct Knowledge of provider/facility billing & insurance practices. Excellent communication and customer service skills. Monitor insurance regulations/updates Subscribe to necessary online services and/or references   Supervisory Responsibility: This position has no supervisory responsibilities   Position Type/Expected Hours of Work: Works a standard 8-hour business day (Billing Office is open Monday-Thursday, 7am-5pm & Friday 7am-4:00 pm) with weekends and major holidays off.  Must be flexible to accommodate staffing shortage as needed. Work Environment: This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other equipment as needed. Requires professional relationships with patients and their family members, Patient Financial Services personnel, physicians’ office personnel, and hospital personnel.   Physical Demands: The physical demands described as follows are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee is occasionally required to stoop, bend, turn, stretch, kneel, or crouch.  Be able to sit for long periods of time, good visual and hearing acuity, able to lift up to 10lbs, push and pull.   Travel: Occasional travel for workshops or in-service for job related training may be required.                                             Work Authorization/Security Clearance (if applicable):   AAP/EEO Statement: Sweeny Community Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.