Billing Specialist
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Job Description
Billing Specialist at Eurofins Scientific overseeing insurance verifications and financial responsibilities for patients. Communicating patient obligations and maintaining compliance with insurance requirements.
Responsibilities:
- Verify patients’ insurance and benefits.
- Communicate patients’ responsibilities.
- Notify management of identified trends as needed, and at month-end, arrange payment plans.
- Enroll patients in Financial Assistance Programs.
- Submit prior authorization requests to payor websites, fax, or phone.
- Obtain medical records or LMNs that the insurance company requests for prior authorization and billing.
- Submit electronic and paper claims to insurance carriers.
- If the patient declines, complete a cancellation form or offer payment options.
- Communicate with clients.
- Offer prompt pay discounts, arrange payment plans, and provide financial assistance as needed.
- Meet daily and monthly departmental productivity goals set by management to achieve the company's financial goals.
- Ensure completion and recording of documentation.
- Be responsible for protecting, securing, and properly handling all PHI (Protected Health Information).
- Research, review, and communicate with insurance carriers regarding open accounts receivable.
- Prepare and submit appeals.
- Timely management of unpaid claims.
- Coordinate the release of medical information to insurance companies, lawyers, state, and federal agencies.
- Meet all audit requests within the allotted time frame.
- Correct claim errors and coordinate, monitor, and manage the follow-up on unpaid claims in a timely manner.
- Collaborate with healthcare providers to resolve pre-certification issues and ensure the timely delivery of medical services.
- Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer.
- Communicate with insurance companies and healthcare providers and review medical records and documentation to ensure compliance with pre-certification requirements.
- Ensure that all payers needing prior authorization are set up correctly within the software system.
- Communicate with private practice, facility, and nursing home clients regarding medical record needs.
- Handle difficult situations involving patients, physicians, or others in a professional manner.
- Perform other duties as assigned and have flexibility to be cross trained to meet departmental needs.
- Maintain accurate and up-to-date records of pre-certification approvals and denials with confidence.
- Attend meetings for updates, communications, and learning opportunities.
- Maintain a good working relationship within the department, with clients, insurance carriers, and other departments.
- Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
- Performs pre-service authorization reviews to obtain payment authorization for outpatient services.
- Succinctly abstracts fact-based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates the clinical information in a timely manner supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.
Requirements:
- Excellent customer service skills, with a focus on professionalism
- Ability to solve problems, prioritize tasks, and multitask effectively
- Goal-oriented mindset with excellent time management and organizational skills
- Strong interpersonal communication skills, including the ability to interact efficiently with individuals at all levels in an organization
- Strong level of empathy & patience
- Excellent verbal and written communication skills
- Attention to detail, accuracy, and time management
- Proficiency in PC-based software such as Microsoft Excel, Teams, iPhone, Adobe, and associated applications
- A fundamental understanding of medical billing concepts
- Knowledge of Medicare, Medicaid, and commercial insurance
- Familiarity with HIPAA (Health Insurance Portability and Accountability) privacy requirements
- Knowledge of Availity and eligibility portals and medical terminology
- Follow up on missing or incorrect information so patients receive the right reimbursement.
- Document account activity using correct medical and billing codes.
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Be investigative to find necessary information, if needed
- Ability to handle multiple priorities and meet deadlines
- Ability to work independently and as part of a team in a fast-paced environment
- Demonstration of self-motivation and ownership of assigned work
- A high level of professionalism and confidentiality in handling sensitive information is imperative.
- Excellent verbal & written communication skills.
Benefits:
- Excellent full time benefits including comprehensive medical coverage
- Dental and vision options
- Life and disability insurance
- 401(k) with company match
- Paid vacation and holidays
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