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Billing and Collection Specialist in Plano, TX at Community Hospital Corporation

Date Posted: 6/21/2018

Job Snapshot

Job Description

Billing and Collections Specialist        
The Billing and Collections Specialist, reporting to the Billing and Collections Manager, is responsible for the billing, timely follow-up and payment posting on all claims  on a daily basis for assigned post-acute hospitals: for communicating the key business office metrics on a daily, weekly, and monthly basis: for coordinating with other third parties such as host hospitals, intermediaries, clearing houses, etc. to ensure prompt payment.  
The Billing Specialist is responsible to provide timely verification of Medicare and insurance benefits on all referrals of potential patients and reviews reports to ensure accurate billing.  
Major Responsibilities
  • Works with staff to ensure accurate admission information is captured
  • Completes timely verification of Medicare and insurance benefits on referrals identified as potential patients
  • Coordinates pre-certifications and insurance verification for all patients
  • Follows up with patients to ensure account accuracy as required
  • Responds to calls from patients about their hospital accounts
  • Bills appropriate payer in accordance with the requirements of the payer being billed
  • Conducts timely follow-up on all accounts
  • Manages detail authorization information from insurance companies
  • Works with CMS/Fiscal Intermediary system (DDE) to identify the prompt flow of accounts through editing, suspense and RTP status
  • Proficient in utilizing a claims management system
  • Corrects accounts on-line for faster processing
  • Assists with month-end AR analysis
  • Manages cash collections
  • Maintains unbilled days at the established corporate goal
  • Maintains bad debt at the established corporate goal
  • Ensures Credit Balance Report is worked daily and quarterly: refunds patients and reverse contractuals as needed
  • Coordinates work with Admissions and Registration
  • Insures that all charges from the acute facility are correctly and timely entered on the patient's account
  • Compiles and provides accurate reports of monthly, quarterly and annual AR statistics
  • Keeps abreast of developments in Medicare, Medicaid, and insurance  admission and billing requirements
General Duties
  • Upholds and supports the company's mission, goals, and objectives
  • Performs other miscellaneous job-related duties as assigned 
Skills and Knowledge
  • Possess specialized working knowledge of current third party billing requirements to include Medicare, Medicaid, insurance and private pay claims
  • Understand billing revenue code and reimbursement
  • Strong integrity and ethical values
  • Possess working knowledge of DDE CMS billing system
  • Ability to utilize online capabilities for checking Medicare and insurance eligibility
  • Ability to communicate and relate well with multiple audiences
    • Communicates openly, respectfully, and in timely way
    • Shares information appropriately
    • Keeps others well informed 
    • Responds in a timely manner to messages/requests
    • Work patiently with patients and payers on admission and billing issues
    • Emails written with proper etiquette, no all-capital letters, basic proper grammar, and spell checked
  • Possess a strong customer and service to others orientation
  • Ability to conduct Independent analysis solve problems
  • Ability to work with Medicare system and be adaptable to changes
  • Ability to remain current with Medicare and other billers' requirements
  • Possess familiarity with Excel software
  • Possess and utilize a core set of ethical values
  • Ability to work in a rapidly changing and stressful environment
  • Ability to sit at a desk using computer and phone for several hours at a time
  • Minimum 2 years hospital billing and account follow-up experience required
  • High School graduation or equivalent required


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