Job Description

Billing Specialist

Masonicare Corporate Services - Wallingford, CT

Day Shift / 40hrs/wk


THIS POSITION IS ON-SITE


Under general supervision from Patient Accounts Management, The Billing Specialist performs a variety of complex operations related to the eligibility, claim preparation, claim submission, suspense resolution, claim follow up and credit balance adjudication/reporting for healthcare services provided to Medicare, Medicaid and Commercial Primary/Secondary beneficiaries. Submits third party claims and resolves billing, payment and collection issues.


Essential Duties and Responsibilities:Review-reports to identify claims that are eligible for billing to intermediaries, insurance companies, third parties and patients. Processes claims and bills in Electronic Medical Record (EMR) system following established procedures.

- Works with - operations to resolve - issues that impact claims processing. Brings problems and delinquent responses to the attention of Manager. Process- corrections - and generate- claims for re-processing. -

Reviews denials and zero pay claims from payor remittance advices, research issues and prepare-claims for resubmission.

- Monitors unpaid claims via accounts receivable -aging, initiate- timely follow up calls and resubmit- claims and/or supporting information to receive- payment from payor. Work- under the direction of Manager to oversee timely collection- - -.

Maintains detailed claim history in collections database. Maintains statistical data and records. May prepare regularly scheduled or special reports on claims, suspense, denials, credit balances and payment activity.

- Responds by telephone or correspondence to inquiries from patients, family, intermediaries or payers. Explain benefit coverage to patients, research- problems and correct-errors.

Identifies and investigates problem delinquencies; follow through with collection policy prior to referral to collection agency, legal action, or write off.


- Meet- defined productivity metrics set up by Manager and maintain- - high-quality standards - -.



- May assist in preparing documentation for appeals, third party audits, legal inquiries, litigation, and court appearances. Assists in special projects as needed. Perform general clerical duties to support the -team.



- Work as a -cross-functional team member b=by providing training to others and -furthering training in our current systems as -appropriate. -Assist in documenting step-by-step task process- for each task and maintain a process manual at workstation.

Follows established departmental policies, procedures and objectives.

Performs miscellaneous job-related duties as assigned.


Minimum Qualifications:

Education: High School Diploma or GED
Experience: 1 to 3 years' experience in healthcare billing.

Day Shift / 40hrs/wk