BILLING AND COLLECTIONS SPECIALIST

The Role:

The Medical Billing Specialist is responsible for managing all aspects of the billing process, including accounts receivable, claims processing, collections, and ensuring the submission of clean claims. This role involves close collaboration with the Admin Billing Manager to optimize revenue cycle management, maintain healthy collections, and ensure timely filing of all claims.

Responsibilities and Duties:

Billing Management

• Claims Processing: Accurately prepare and submit claims, ensuring compliance with payer requirements. Monitor claim statuses and address any issues promptly to prevent delays.
• Timely Filing: Ensure that all claims are submitted within payer-specific deadlines to avoid denials due to late filing. Maintain a tracking system to monitor and meet all filing deadlines.
• Claims Reprocessing: Identify and reprocess denied or rejected claims quickly, ensuring that they are corrected and resubmitted within the allowed time frame to secure payment.
• Accounts Receivable (AR) Reporting: Regularly monitor and report on accounts receivable, tracking outstanding balances and working closely with the Admin Billing Manager to address overdue accounts.
• Healthy Collections: Actively manage the collections process, including patient responsibility collections, to maintain healthy cash flow. Follow up on unpaid balances, coordinate payment arrangements, and escalate delinquent accounts as necessary.
• Clean Claims Submission: Perform thorough reviews of documentation and coding to ensure clean claims submission, reducing the likelihood of denials and improving payment rates.
• Patient Billing: Provide clear and timely communication with patients regarding their financial responsibilities, including detailed explanations of charges, payment options, and handling billing inquiries efficiently.
• Billing Coordination: Collaborate closely with the Admin Billing Manager to ensure that all billing tasks are completed accurately, efficiently, and on schedule.
• Weekly Billing Tasks: Organize and execute billing activities on designated days, ensuring all tasks are handled with precision and within required timeframes.

Credentialing Management

• Provider Credentialing: Manage the credentialing process for providers, ensuring that all necessary documentation is up to date and compliant with payer requirements.
• Platform Management: Maintain and update credentials using Med-Trainer, Availity, Provider Express, and other credentialing platforms as required.

Authorization Management

• Authorization Tracking: Monitor authorization deadlines, submit new authorizations, and manage re-authorizations for ongoing services. Ensure all documentation is accurate and up to date in the relevant systems.
• Communication: Keep the Admin Billing Manager informed of any issues related to authorizations before the expiration of the current authorization, ensuring continuity of service and payment.

Audit Support

• Audit Requests: Efficiently process medical records requests during audits, ensuring that all necessary documentation is prepared and submitted in a timely manner to meet audit requirements.

Revenue Cycle Optimization

• Process Improvement: Continually seek ways to enhance the billing process to increase efficiency, reduce claim denials, and improve overall revenue cycle performance.
• Compliance with Payer Requirements: Stay informed on payer-specific billing guidelines and regulations to ensure compliance, timely filing, and to minimize the risk of denials.

Cross-Departmental Communication

• Authorization Issues: Proactively communicate any issues related to authorizations with the Admin Billing Manager before the expiration of the current authorization, ensuring continuity of service and payment.

Reporting and Analytics

• Departmental KPIs: Regularly track and report on key performance indicators (KPIs) related to billing operations, including metrics on claims processing time, denial rates, collection effectiveness, AR aging, and timely filing rates.
• Performance Reporting: Prepare and present detailed reports on billing performance to the Admin Billing Manager, providing insights and recommendations for improving departmental efficiency and revenue generation.

Supporting Role

• Department audits
• Department projects
• Human Resources

Qualifications

• Medical billing certificate completion is highly preferred
• Experience in behavioral health (ABA) billing preferred
• 3+ years' experience in medical billing and end-to-end collections in the USA
• Proficiency in data entry
• Proficiency in Microsoft Office (Excel, Word, Outlook, etc.)
• Central Reach experience preferred

Work Arrangement:

• Must be willing to work onsite (Ortigas)
• Predominantly night shift, but must be amenable to shifting schedules

About The Company:

Outsource Accelerator is the trusted source for independent information, advisory and expert implementation of Business Process Outsourcing (BPO). We are the #1 Outsourcing Authority, and we offer the worlds leading aggregator marketplace for outsourcing.

We specifically provide the conduit between Philippines outsourcing suppliers and the businesses clients across the globe. We continue to provide world-class talent to help small and medium-sized enterprises successfully build their offshore team in the Philippines.