Client Services Specialist - Medical Billing

GENERAL RESPONSIBILITIES: Be the primary means by which denied claims are paid, patient and office inquiries are answered, and client accounts are maintained according to the standards defined by the company and the client.

 

SPECIFIC RESPONSIBILITIES:

 

?  Research and pursue denied claims for payment using the most appropriate method to obtain payment in a timely fashion. Some of the methods are involving appropriate client personnel, calling patients or insurance companies and making use of the company?s or the client?s information systems.

 

?  Resolve, in a knowledgeable, courteous, polite and friendly manner, inquiries and problems from patients, physicians, practice staff, and third party payers.  Maintain the HART Associates Inc. goal of being an extension of the practice.

 

?  Insure that the age of receivable for the clients to whom you are responsible is within the boundaries established by the client and the company as communicated to you by the accounts receivable supervisor.

 

?  Establish and maintain a professional business relationship with the client?s business office, patients and insurance carriers.

 

?  Actively promote a positive and courteous work environment and display a willingness to work with others to insure the team?s success.

 

?  Understand and support the company?s OIG (Office of Inspector General?s) Compliance policy as defined in the Corporate Compliance Plan ? Summary and Employment Agreement booklet

 

?  Other duties as assigned by supervisor or management.

 



SPECIFIC DAILY EXPECTATIONS:

  Answer telephones, update insurance information based on information received via calls, and post denialsResolve claims on weekly denial reportWork critical claims reports  Filing, note match up, miscellaneous paperwork, etc. Review/resolve prior month unidentified cash log.

 

SPECIFIC WEEKLY FUNCTIONS:

 

?  Run critical claims reports weekly to address the following:

?  Billing deadlines ? 60-85 days Medicaid, HMO Blue, Secure Horizons, HCHP, Tufts insure that claims have been rebilled

?  Call on all commercial, worker?s comp, MVA, legal and appeals over 42 days 

?  Review/resolve all Medicare claims over 42 days 

?  Review/resolve all claims over $500

?  Any other critical categories as assigned.



MISCELLANEOUS RESPONSIBILITIES:

 

?  Keep supervisor informed of any backlog. Notify supervisor of any potential problem areas or training issues ? such as front end training, data entry or cash posting training, claim production issues.Make suggestions and assist with implementation of processes that increase cash collections.If unavailable for assigned telephone schedule, review with supervisor to insure adequate coverage.