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Billing and Collections Specialist

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- Prepare and submit accurate claims to insurance companies using the clinic’s electronic health record and billing software.
- Verify and correct claim information to avoid denials and ensure compliance with payor requirements.
- Review denied claims, investigate reasons for denial, and resubmit corrected claims in a timely manner.
- Generate and send accurate patient statements, ensuring they reflect current balances and itemized services.
- Monitor accounts receivable, following up on outstanding patient balances through phone calls, letters, and other communication channels.
- Set up and manage payment plans with patients who need assistance with their balance, ensuring timely collections and maintaining accurate records.
- Verify patient insurance coverage and benefits as needed to ensure accurate billing and eligibility.
- Coordinate with front desk and clinical staff to address any discrepancies in insurance information and resolve issues before claims submission.
- Communicate with insurance representatives to address payment discrepancies, authorization issues, and claim adjustments.
- Respond to patient inquiries regarding their statements, insurance coverage, and payment options with clarity and professionalism.
- Educate patients on their financial obligations, including co-pays, deductibles, and out-of-pocket costs.
- Assist patients in understanding their insurance benefits and financial responsibility by explaining statements and answering questions.
- Implement and maintain collections processes for overdue accounts, following clinic policies for escalation.
- Track and report on accounts in collections, providing updates to management and making recommendations for potential write-offs or further action.
- Work with third-party collections agencies as needed to facilitate the recovery of delinquent accounts.
- Accurately document all billing and collections activities in the EHR and billing systems.
- Generate and review regular reports on accounts receivable, aging balances, and collections performance, identifying trends and opportunities for improvement.
- Participate in regular audits of billing practices to ensure compliance with clinic policies, healthcare regulations, and payor requirements.
- Proficiency in EHR and billing software, with knowledge of CPT, ICD-10, and HCPCS coding.
- Strong understanding of insurance claims processes, payer rules, and healthcare billing regulations, including Medicare.
- Excellent communication and customer service skills, with the ability to explain billing concepts to patients.
- Attention to detail, problem-solving skills, and the ability to manage multiple accounts and tasks efficiently.

The Billing and Collections Specialist is responsible for overseeing patient billing and accounts receivable processes to ensure accurate and timely payment collection. This role includes submitting insurance claims, following up on outstanding balances, resolving billing discrepancies, and providing patients with guidance on their financial responsibilities. The ideal candidate has a strong background in medical billing, knowledge of healthcare insurance, and excellent problem-solving skills.

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