Investigate account balances and cause for non-payment, initiating claim adjustments, and re-submitting a clean claim to the payer or billing to patient.
Complete appeals within established time frame to avoid write offs.
Identify root cause of denials and create optimal solutions to prevent future denials; compose appeal letters for accounts denied and obtain necessary documentation.
Complete cash reconciliation.
Assist patients with billing, service and insurance questions; discuss accounts by phone and/or other electronic means to address concerns, verify insurance is properly billed and financial assistance posted.
Update systems with insurance or patient demographic corrections; verify new insurance information with payers; submit/resubmit claims.
Accept payments and post to the account systems.
Assist collection agencies to ensure uninterrupted self-pay collections.
Set up payment plans, post payments, and complete end of day processing.
Read, analyze and interpret contract documents.
Prepare records, reports, summaries, analyses, evaluations, and recommendations; develop statistical data.
Provide assistance to other department regarding insurance policies, collection processes, and billing.
Document encounters and action in appropriate systems.
Demonstrate integrity, innovative thinking, and make an active contribution to the success of the organization.
Comply with policy and procedures, confidentiality, and HIPAA policies and requirements.
Perform other duties as assigned.

Bachelors in a related field plus one (1) year of experience in a healthcare revenue cycle related function or equivalent combination of education and experience
Associate’s degree in a related field plus three (3) years of experience in a healthcare revenue cycle related function
High School diploma/GED plus five (5) years of experience in a healthcare revenue cycle related or bookkeeping function
Must be familiar with Windows environment with the ability to accurately read, analyze, and interpret contract documents for all payers to determine reimbursement; analyze credit balance
Preferred: Knowledge of EPIC billing system.

Senior Clinical Billing Specialist

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