Insurance Verification/Billing Specialist

Description

SUMMARY OF RESPONSIBILITIES

• The Patient Financial and Billing Representative is responsible for assisting patients with financial and billing inquiries. He/she is also responsible for running and providing accurate reports to multiple departments regarding a variety of data.

ESSENTIAL FUNCTIONS

• The Patient Financial and Billing Representative with assist with eligibility for scheduled visits in clinic and ASC setting.
• Responsible for assisting with cost estimates for scheduled procedures in ASC setting.
• Reviews patient bills for accuracy and completeness and obtaining any missing information.
• Calls insurance companies for clarification on benefits for patients when necessary.
• Identifies and bills secondary or tertiary insurance.
• Reviews accounts for insurance of patient follow-up.
• Answers all patient or insurance telephone inquiries pertaining to assigned accounts.
• Sets up patient payment plans and work collection accounts.
• Updates billing software with rate changes and notifying all necessary departments of the changes in a timely manner.
• Runs accurate Front desk collection reports monthly and reporting to appropriate staff.
• Is the primary point of contact for Patient Support Representatives for all billing inquiries and assisting patients with understanding their charges and outstanding balances.
• Assists patients with coordination of benefits and notifying staff when they have been resolved.
• Maintains a comprehensive knowledge of the policies of all insurance carriers, including Medicare and Medicaid, that PTCOA, AFCI, and FCCOA accept.
• Maintains a comprehensive knowledge of all providers credentialing status with each individual entity. 
• Actively assist patients with understanding their out-of-pocket expenses, explaining benefits including co-payments, co-insurance, deductibles, and coordination of benefits. Patients should know what they are expected to pay at the time of service.
•  Explains and arranges patient payment plans, alternative financing, and charity programs.
• Processes patient payments and correctly updates patient accounts and balances. 
• Assists in overseeing accurate cost estimates are provided to the patient.
• Assists patients with financial assistance applications in accordance with PTCOAs financial assistance policy.
• Performs other related duties as assigned.

Requirements

CORE COMPETENCIES

• Excellent oral and written communication skills
• Excellent skills in customer service and communications
• Knowledge of current medical terminology to communicate with physicians, staff, and patients.
• Strong telephone communication skills
• High level of attention to detail
• Strong organization, filing, and time management skills.
• Basic computer literacy and typing
• Patient focused.
• Self-starter and comfortable with working independently while providing timely and accurate status reports.
• Ability to prioritize and manage multiple tasks without direct supervision.
• Multi-tasking abilities, along with ability to work well under pressure, prioritize and meet tight deadlines.
• Must be able to work independently in a fast-paced environment and exhibit strong written and verbal communication skills.
• Strong customer service and prompt problem-solving skills including the ability to provide diligent, prompt, and courteous responses to patient questions/issues.
• Take initiative to do to redo inadequate or incomplete work, even if it is not yours.
• Ensure compliance with regulatory standards.
• Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Minimize non-productive time and fill slow periods with activities that will enable you to prepare to meet the future needs of the company (education, organizing, housekeeping, assisting others).
• Organize job functions and work area to be able to effectively complete varied assignments within established time frames.
• Consistently demonstrate ability to take the initiative to make decisions/choices without direct supervision.
• Adhere to administrative and departmental policies.
• Demonstrate regular attendance and timeliness.
• Do not incur excessive overtime.
• Remain conscientious in regard to personal hygiene.
• Demonstrate knowledge and understanding of all policies and procedures and ability to reference them from appropriate sources.
• Demonstrate adherence and support of company-wide service standards as evidenced by observation and feedback from patients, family members, and other clients.