ASC Billing Specialist/Account Auditor

About the Role:

Responsible for overseeing the revenue cycle processes, including eligibility verification, customer service, prior authorization, coding/charge entry, claim submission, denial management, payment posting, and reporting. You will be the primary contact and problem solver for all third-party companies involved in revenue cycle activities.

What You’ll Be Doing 

• Responsible for ensuring the final resolution of all insurance and guarantor owed balances.  This would include, but not be limited to, follow-up and resubmission of claims not on file, filing of appeals for claims denied in error, collection of guarantor balances in accordance with written policy, electronic and telephone communication with payers and refunds.

• Responsible for maintaining the day-to-day operations.

• Ability to troubleshoot billing problems for all Revenue Cycle departments

• Responsible for communicating incorrect filing issues that result in claims being denied to the office staff and the Administrator.

• Responsible for developing relationships with representatives of all payers to help resolve issues regarding claims payment, denials, policies, and problems.

• Monitoring of aged accounts balances, both insurance and guarantor types, ensuring compliance within corporate benchmarks set in accordance with the MGMA for superior performance.

• Oversee the collection activity in accordance with the Corporate Collection Policy.

• Oversee the charge entry/coding activity in accordance with billing policy.

• Responsible for knowledge of the computerized collections module and patient accounts system concerning processes and documentation necessary to support the collection procedures.

• Responsible for ensuring appropriate documentation to support write-offs, transfers to collection agencies, and adjustments to all accounts.

• Responsible for random audits of all positions to ensure compliance with Corporate and Departmental policies and procedures.

• Maintain working relationships with other supervisors and clinical leaders to ensure communication, cross-training and resolution of problems.

• Responsible for adhering to the Corporate Confidentiality Policy.

• Other duties as assigned.

What We Expect from You 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• High School Diploma or equivalent required; AA/AS degree or Certified Coder Certification preferred.

• Minimum of 3-5 years’ experience in collection of medical accounts receivables

• Knowledge of Revenue Cycle components

• Knowledge of all third-party payor regulations and compliance policies

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine correspondence. Ability to speak effectively before individuals or groups of people.

Mathematical Skills  

Ability to calculate basic figures and amounts.  Ability to apply concepts of basic algebra and geometry.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills

To perform this job successfully, an individual should have knowledge of basic computer software.

Other Skills and Abilities  

• Excellent written and verbal communication skills

• Excellent organizational skills

• Ability to meet standard productions goals

• Ability to handle multiple tasking

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl and talk or hear. The employee must frequently lift and/or move up to 10 pou