Patient Accounts Billing Specialist (Part Time)

Cosmetic Surgery; Vernon Hills (IL); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Patient Accounts Billing Specialist to ensure accurate billing and maximize revenue collection in a dynamic healthcare environment. This role requires a blend of expertise in medical coding, strong communication skills, and a commitment to compliance. The ideal candidate will thrive in a fast-paced setting, managing patient accounts while supporting the Revenue Cycle Manager. With a focus on continuous improvement and training, you'll play a critical role in enhancing the patient experience and ensuring adherence to healthcare regulations. Join a team dedicated to excellence and make a meaningful impact in patient care.

Qualifications

• 3+ years of experience in medical billing and coding required.
• Bachelor's degree or equivalent experience necessary.
• Strong knowledge of medical terminology and coding guidelines.

Responsibilities

• Manage patient accounts and ensure accurate billing practices.
• Prepare financial estimates and communicate with patients effectively.
• Support training and mentoring on billing processes and coding.

Skills

ICD-10-CM and CPT coding

Medical terminology

Organizational skills

Communication skills

Data analysis

Confidentiality maintenance

Education

Bachelor's degree in relevant field

Equivalent experience and training

Tools

Microsoft Office Suite

Nextech PM and EMR

Trizetto

Klara

Job description

The Patient Accounts Billing Specialist is responsible for verifying patient insurance coverage, interpreting benefits plans, processing patient procedure estimators, deductibles and co-insurance balances, performing prior-authorizations and pre-determinations for patient services, and ensuring accurate billing practices by thoroughly understanding the details of various health insurance policies to maximize revenue collection for our healthcare providers, all while adhering to compliance regulations. Effective and efficient communications with insurance payors, providers and patients is paramount for success in this role. The Specialist is also to support the Revenue Cycle Manager in assisting with all patient financial transaction matters including revenue cycle; deposit/pre-payments made via cash or credit card; service episode payments made via cash or credit card; insurance payments; and, where applicable, refund payments and balance due follow-up activities. Where applicable, this individual will identify process/workflow improvement opportunities to ensure an ongoing state of compliance and actively assists in implementation, training, and follow-up by others. Duties must be executed in a manner that upholds the practice's standards of excellence and in accordance with Federal, State, company, and employee handbook policies and procedures.

KNOWLEDGE, SKILL, & EXPERIENCE REQUIREMENTS

• Bachelor's degree from an accredited four-year college or university or equivalent combination of experience, education, and training that would provide the required knowledge and abilities
• Knowledge of ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines
• Three years or more of related experience required
• Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff
• Excellent organizational and time management skills
• Proficient in Microsoft Office Suite
• Experience in Nextech PM and EMR, Trizetto and Klara are preferred but not required
• Ability to work in an environment where multi-tasking is required
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations
• Ability to read and interpret medical procedures and terminology
• Ability to develop training materials, make group presentations, and to train staff
• Ability to exercise independent judgment
• Consistently maintains confidentiality on all patient accounts and business matters

RESPONSIBILITIES

The essential functions include, but are not limited to:

PATIENT ACCOUNTS MANAGEMENT

• Prepares financial responsibility/out of pocket estimates for patients. Documents and properly uses practice management software to ensure transparency with respect to financial responsibility obligations and transactions.
• Intimately knows and employs our fee schedule relative to subscriber benefits to ensure accurate estimate generation
• Makes good faith attempts to notify patients of estimated amounts as quickly as possible. Where appropriate, contacts patients/guarantors for payments and balances due.
• Proactively monitors and reviews provider schedules for events such as add-on exams/procedures or schedule changes. Acts in a swift and decisive manner to ensure changes follow pre-authorization/pre-payment workflow and that we support the patient experience as best we can.
• Manages Pre-certifications/Prior authorizations, initiating and coordinating with specialty pharmacies for treatment authorization and therapy deliveries
• Actively participates in training, coaching, and mentoring others on the billing eligibility and estimator workflow to ensure all teammates are well informed and meet best practice standards
• Answers phone and electronic messages/needs in a timely, polite and respectful manner; works hard to ensure priorities are set and deadlines are accomplished at all times throughout the operating year
• As needed, participates in the preparation of business activity reports

BILLING & CODING

• Supports the efforts of the practice and Revenue Cycle Manager to manage accounts receivables; work externally to support claims concerns or issues; and ensures documentation for billing batches, EOBs, and outstanding claims are made in a timely manner
• Participates in the insurance billing function of the business office, and sees to the proper application of patient, insurance, and other payments
• Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM and CPT codes.
• Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation
• Educates and advises staff on proper code selection, documentation, procedures, and requirements
• Identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the collection and coding of quality health data as it relates to procedure estimators

POLICY ADHERENCE

• Adherence to company, Federal, State, locality-specific policies and procedures
• Understand, abide, and enforce the Employee Handbook
• Demonstrate adherence to dress code standards
• Demonstrate adherence to life safety practices standards
• Uphold strict confidentiality by abiding to HIPAA regulations and identity theft policies

We are a drug-free, equal-opportunity employer. Reference and background check required.