General Summary:

The BPN Billing Specialist is responsible for the accurate submission of all claims to third party payers according to policy and billing regulations and the collection of accounts from third party payers and patients. Ensures that compliance standards are supported and works closely with patients, families, attorneys, outside agencies, third party payers and internal Bryan Health personnel to secure resolution of accounts while maintaining superior customer service. Responsible for clerical duties as assigned.

Job Tasks and Responsibilities:
(*denotes essential job functions)

1. *Commits to the mission, vision and beliefs of Bryan Health and consistently demonstrates our core values.
2. *Downloads and organizes information from the Electronic Health Record (EHR) systems as needed for billing.
3. *Performs necessary clerical duties to complete billing tasks and document appropriate communication; files work documents and reference materials as needed.
4. Provides support to Central Business Office (CBO) personnel as requested.
5. *Conducts skip tracing efforts in an attempt to locate guarantors with return mail or bad addresses.
6. Receives incoming mail and distributes to appropriate staff.
7. *Reviews accounts for alternate forms of resolution and possible eligibility of Charity Care or Financial Assistance.
8. *Cross references and verifies information from the EHR systems as needed for billing.
9. Performs other related duties as assigned.

Third Party Payer Account Focus

1. *Posts incoming checks and processes EOB's accurately
2. *Works denials on the EOB's to completion.
3. *Responsible for following up and processing returned claims, reports, requests for information and resubmissions.
4. *Monitors all outstanding unbilled claims and reports any concerns to manager.
5. *Maintains current billing guidelines and third party payer regulations.
6. *Reviews all claims for correct and complete patient and insurance information.

Patient Account/Self-Pay Focus

1. Answers patient billing calls.
2. *Reviews all patient balances for correct and complete amounts and demographic information
3. *Posts all patient payments in the Practice Management (PM) system.
4. *Reviews accounts for alternate forms of resolution and possible eligibility of Charity Care or Financial Assistance.
5. *Processes patient statements and conducts statement audits with ibill reports and PM reports; corrects account information as necessary.
6. *Reviews delinquent accounts; prepares payment plans and monitors adherence according to guidelines.
7. *Processes deceased notices for estate demands and claims; processes bankruptcy notices as appropriate; processes charity care applications and submits for approval and performs adjustments as required.
8. *Researches, requests and documents refunds on patient credit balances.
9. *Responsible performing and monitoring the in house collection process and preparing accounts for submission to third party collection agency.

Minimum Qualifications:

High school diploma or equivalent required. Minimum of two (2) years insurance billing experience in a clinic or hospital setting required. Prior patient accounting experience desired.