Collections Specialist - Dean McGee Oklahoma Health Center

Position Title:

Collections Specialist - Dean McGee Oklahoma Health Center

Department:

General Overhead

Job Description:

General Description: The Billing Representative is responsible for all claim submission activities and performing a variety of complex clerical, coding, and accounting functions for physician billing.  Duties include, but are not limited to, routine electronic billing, ensuring claims are accurate prior to submission, working clearinghouse rejections, problem solving for various government and commercial payers, paper claims submission, and 837 file creation and upload.  The Billing Representative will have knowledge and understanding of Health Care Finance Administration (HCFA) 1500 coding and billing guidelines, modifier placement, authorization requirements, and reimbursement expectations for all government and commercial payers.

Essential Responsibilities:

• Ensures all billable claims are processed electronically each day.
• Mails paper claims when necessary with appropriate documentation.
• Reviews and resolves all clearinghouse claim rejections daily.
• Monitors the accuracy of patient demographic and insurance information entered by physician office staff and performs staff training on errors, as necessary.
• Audits charge batches from physician office staff to ensure proper data entry of charges, modifiers, code linkage, etc.
• Reviews any late charges submitted by clinic staff for possible claim resubmission.
• Rebills corrected claims as requested.
• Uploads charges for all procedures and office visits.
• Reviews clearinghouse acceptance reports to verify claim receipt by insurance company.
• Assists Claims Analyst with submitting reconsiderations and appeals.
• Develops familiarity with each assigned clinic and physician and any special handling required for their particular billing.
• Ensures claims are accurate prior to submission.
• Documents concisely, precisely, and accurately on all records or documents as indicated by policy.
• Participates in QA activities as directed.
• Assists in both day-to-day and special projects and performs other duties as assigned.
• Compiles statistical data for reports and records.
• Periodically works with their Manager to review and discuss individual work accomplishments, work problems/barriers, progress in mastering tasks and work processes, individual training needs, and career progression.
• Assists fellow team members and other departments as necessary.
• Communicates regularly with other team members and manager regarding trends and new guidelines/edits.
• Answers incoming phone calls as necessary.
• Supports period-end closing procedures.

General Responsibilities:

• Performs other duties as assigned.

Minimum Qualifications:

Education:  High School Diploma or GED.  Bachelor’s degree preferred.

       

Experience:   2 or more years of professional work experience required.  4 or more years of experience in HCFA 1500/UB-04 billing experience preferred.  Electronic billing and clearinghouse software experience in a multi-specialty clinic setting highly preferred.

Licensure/Certifications/Registrations Required:  None required.

Knowledge, Skills and Abilities:

• Must understand Accounts Receivable principles and procedures.
• Extensive knowledge of reimbursement systems, federal, state, and payer-specific regulations and policies pertaining to documentation, coding and billing.
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of standard reference applications (CPT, ICD-10, HCPCS, DRG)
• Regular, physical attendance on a predictable basis is essential to the performance of this job.
• Experience with standard claims forms and coding used for physician/hospital billing.
• Must be highly motivated and work well both independently and in a team environment.
• Must be trustworthy, accurate, self-reliant and organized.
• Needs excellent judgement and creative problem solving skills.
• Must have experience with Electronic Medical Records (EMR) and Practice Management software.
• Ability to use computer systems, various applications, and operate office equipment.
• Must communicate effectively with insurance representatives, clinical and administrative staff, and other team members.
• Ability to function effectively in a fast-paced and changing environment with multiple priorities and objectives.
• Knowledge of accepted medical abbreviations and their meanings and interpretation.
• Ability to evaluate processes and procedures for continuous process improvement.
• Knowledge of Medicare and Medicaid programs.
• Knowledge and understanding of medical terminology.
• Knowledge of clinic office procedures.
• Ability to use proper grammar, spelling, punctuation and sentence structure to answer correspondence and reports.
• Ability to plan, organize and oversee workflow.
• Ability to balance multiple priorities and handle challenging situations.
• Experience with 837 file creation and website uploads.
• Knowledge of authorization requirements.
• Expected to cross train to serve as a backup for other functions of the physician billing team.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.