Job Description

Department: Billing

Position: Billing Specialist - Bilingual Required (English/Spanish)

Employee Category: Non-Exempt

Reporting Relationship: Manager of Revenue Cycle Management

Character First Qualities:

Decisiveness- The ability to recognize key factors and finalize difficult decisions.
Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice.
Flexibility- Willingness to change plans or ideas without getting upset.
Patience- Accepting a difficult situation without giving a deadline to remove it.
Tolerance- Accepting others at different levels of maturity.

Summary of Duties and Responsibilities:

The Billing Specialists coordinates various aspects of patient procedures performed by Variety Care providers. Specialty billing includes building a liaison with insurance carriers, patient payment counseling, billing and coding, managing claims processing to ensure payment, working denials, collections, and other billing duties as assigned. The Billing Specialist Coordinator will also respond to both oral and written communication from patients and staff in a timely and accurate manner.

Primary Duties and Responsibilities:

Responsible for revenue cycle management of all Women’s Health claims to include pregnancy, procedures/surgeries and Long-Acting Reversible Contraception (LARCs).

Performs all duties of Billing Specialist Coordinator in the event that they are out of the office.

Responsible for revenue cycle management of all specialty billing to include special programs, grants, and other as assigned.

Counsels patients as to estimated costs of procedure and set up payment plans if appropriate.

For patients with insurance – verifies benefits, requests pre-authorization for procedures, collects deductibles and co-insurance prior to procedure.

For self-pay patients – verify proof of income for the sliding fee scale, collect payment and/or set up payment plans if appropriate.

Assists with scrubbing and coding claims, working denials and posting payments.

Manages assigned A/R to include Women’s Health, specialty billing and Orthodontics by working denials and making collection calls to patients and insurances.

Identifies and communicates trends with payers to the Manager of Revenue Cycle Management and Providers when appropriate in order to maximize revenue and prevent denials.

Follows up with patients on payment plans and collections as necessary.

Remains current on Medicaid, Medicare and Private Insurance filing rules.

Prepares and submits monthly Provider payouts to Payroll in a timely manner.

Prepares and submits monthly Orthodontic report to Accounting for payment.

Tracks and reports LARC claims on a monthly basis to ensure payment accuracy and price evaluation.

Generates monthly statements to patients.

Responsible for communication with patients concerning billing and insurance if applicable.

Responsible for assuring charges and adjustments are closed out on a daily basis.

Prepares month end reports in a timely manner.

Follows HIPAA guidelines and Variety Care privacy policy.

Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable. Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.

Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.

Performs other duties as assigned.

Requirements, Special Skills or Knowledge:

High school diploma or GED.

Two years recent experience with CPT and ICD-10 coding, familiarity with medical terminology as well as filing third party claims with a preference in medical procedures.