Medical Billing & Collection Specialist - HCM Practice Support - USA Health Physicians Group at USA Health

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

Responsibilities

• The Medical Billing & Collections Specialist professional responsibility within their scope of practice:
• Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization's values.
• Adheres to hospital policies including confidentiality.
• Require regular and prompt attendance.
• Work the assigned schedule including overtime and call as required.
• The Medical Billing & Collections Specialist department responsibilities:
• Requires minimal supervision to safely perform essential functions.
• Utilizes proper body mechanics when moving equipment/supplies that is necessary to perform essential functions.
• Answers incoming calls/assists walk-ins.
• Fields complaints and disputes to the proper personnel.
• Works encounter interrupts daily.
• Works e-mail daily.
• Reviews and monitors in-house encounters.
• Works incoming correspondences.
• Weekly completes encounters in work queues.
• Sets contact terms on encounters, which meet minimum payment requirements.
• Follows up on delinquent final payment plans.
• Prepares encounters for audits and documents and charges with results of audit.
• Researches self-pay encounters for insurance coverage and forwards information to proper area for encounter update.
• Prepares encounters for recommendation of refund.
• Verifies employment and checks probate court for property and estate claims.
• Reviews discharged patients for correctness of patient and insurance information and necessary forms.
• Recommends encounters for suit or placement with an outside collection agency or attorney.
• Reviews Mobile County Record for court action involving patient encounters.
• Submits encounters for estate filing.
• Maintains a thorough and current knowledge of billing requirements and reimbursement methodology for all assigned coverages.
• Maintains reports and lists as required by management.
• Collects and reconciles encounters for assigned coverage.
• Answers telephone and provides information on patient statements/correspondence with the appropriate follow-up.
• Responds timely and accurately to written billing inquiries from patients and/or insurance companies.
• Makes necessary demographic and insurance additions, deletions, and changes to the system guarantor/patient information.
• Utilizes online systems for follow-up and reconciliation of encounters.
• Works audit reports received from insurance companies.
• Maintains encounter integrity by ensuring that insurance pro-ration, adjustments and transactions are accurate.
• Reconciles encounters from insurance Explanation of Benefits.
• Monitors insurance payments and allowances for proper reimbursement per contract.
• Reconciles credit balances.
• Checks work items and email daily and takes appropriate action.
• Identifies solutions to work related problems and issues.
• Requests medical records as needed and follows up on receipt of same.
• The Medical Billing & Collections Specialist communication responsibilities:
• Communicates and uses appropriate customer relations skills with physicians, patients, families and USA personnel in person and via telephone.
• Communicates work-related problems and issues to supervisor or management staff.
• The Medical Billing & Collections Specialist documentation responsibilities:
• Maintains accurate and complete records by documenting all follow-up activities with insurance company or patient clearly and concisely on the patient encounter.
• Maintains proper filing of patient and insurance correspondence to include Explanation of Benefits and insurance denials.
• Maintains contact file folder on all patients with established contract terms.
• The Medical Billing & Collections Specialist citizenship responsibilities:
• Accepts and completes all duties positively and without conflict.
• Cooperates, helps others and improves the performance of the unit.
• Completes all mandatory unit, educational and hospital requirements.
• Utilizes cost effective practices in performing all aspects of the job.
• Adheres to current Infection Control and Safety Standards.
• Other duties as assigned/required. Participates on committees as assigned. Participates in Performance. Improvement activities through quality measurement or participation of ICARE process as assigned.
• Completes all mandatory department, educational and hospital requirements
• Adheres to current Infection Control and Safety Standards
• Regular and prompt attendance
• Ability to work schedule as defined and overtime as required
• Related duties as assigned

Additional Information

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

Qualifications

• High School Diploma and 1 year medical billing and/or collections experience in a medical office setting. Required
• Hospital billing and claim follow-up experience relating to commercial, UHC and Medicare Advantage plans Preferred
• Comparable combination of education and experience may substitute for the above requirements.

Equal Employment Opportunity/Affirmative Action Employer

The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis. EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.