Business Office Specialists (Billing Specialist)-RMF Revenue Cycle
Company: DHR Health
Posted on: May 22, 2023
Position at DHR Health
This position is responsible for business office activities which
include collection of accounts receivable, patient billing,
customer service, cashiering, refunds/recoupment's, appeals, and
provides refunds for services to patients and third party payers as
needed. This position requires that at least three (3) of the
functions above are able to be performed.
- High School Diploma/GED is required
- Comprehensive knowledge of healthcare reimbursement.
- Understands medical terminology
- Familiarity with EOB's and RA's
- Knowledge of Microsoft Office suite, working knowledge of Excel
- Excellent Customer Service
- Good written and verbal communication skills required
- Must be able to multi-task
- Ability to read, write and speak English
- Ability to communicate clearly and concisely with all levels of
- Bilingual - English/Spanish, preferred
- Previous healthcare experience (2-3 yrs.) required, hospital
- Communicates clearly and concisely and is able to work
effectively with other employees, patients and external
- Establishes and maintains long-term customer relationships,
building rapport with other department staff
- Demonstrates proficiency in Microsoft Office applications, be
able to type at least 35 WPM, and good working knowledge of Excel
- Able to perform basic mathematical calculations, balance and
reconcile figures, punctuate properly and spell correctly.
- Medical Terminology, ICD-9, ICD - 10, Codes, CPT Codes, HCPCS
code, Modifier knowledge required.
- Ability to use the internet to obtain information from Third
Party Payers or other sources is required.
- Requires working with minimal to moderate interruptions
- Promotes the facility mission, vision and values by effectively
communicating them to others. Considers mission, vision and values
in developing services, standards and practices
- Receives incoming and outgoing calls from patients and informs
them of their balance due after insurance has paid.
- Assists patients and carriers with questions and concerns
regarding the billing and collections of accounts.
- Obtains copies of required insurance identification cards, as
- Works special projects as assigned.
- Assist with posting payments and identifying correct
- Daily download and review report of patient balance for
- Update address on return mail as needed
- Review RAs and EOB's total charges, amount of insurance payment
and balance owed by patient or responsible party.
- Explains hospital payment policies and collects patient balance
due and writes receipts for all payments collected.
- Performs daily reconciliation of petty cash.
- Download and post electronic remits and apply payments and
adjustments as per I-plan.
- Make deposits to the bank.
- Researches credit balances for accurate processing of refunds
due to over payments and/or allowances requiring a correction in a
- Prepares credit worksheet and processes all transactions
required to request refund checks or to correct account
- Transfers patient credit balances to outstanding accounts
according to hospital policy and procedure, and prepares letters of
explanation concerning refund issued to third party payers and
- Researches and prepares quarterly Medicare credit report.
- Responds to all mail and phone calls concerning credit balances
and refunds checks.
- Completes provider applications for payers
- Follows-up accounts on assigned ATB and/or custom reports and
contacts insurance carrier for payment and/or recoupment's.
- Enter appropriate mnemonic in the notes tab
- Utilizes tickler, when requesting additional information from
other co-workers or departments
- Responds to correspondence from insurance carriers in a timely
- Determines financial status and refers patient for financial
screening as appropriate
- Ability to identify accounts that need insurance billing or
- Adheres to collection tips booklet when contacting insurance
- Demonstrates proficiency in billing and follow up of Medicare,
Medicaid claims on-line or through billing software
- Proficient in accessing information needed from Cerner and AX
document imaging software.
- Request copies of medical records from HIM for any paper
- Ability to access medical records from Cerner system to appeal
claims with carriers.
- Enter and maintain appealed accounts through the variable data
- Maintain PMMC software system for carrier over and under
payments to facility.
- Create appeal letters with appropriate details of appeal
- Select correct adjustment codes on adjustment form to
appropriately document reason for adjustment
- Complete adjustment form appropriately with the correct dollar
amount assigned to the adjustment code
- Ensures patient confidentiality requirements are met in
accordance with HIPAA policies and procedures.
- Other duties as assigned.
Keywords: DHR Health, McAllen , Business Office Specialists (Billing Specialist)-RMF Revenue Cycle, Accounting, Auditing , Mcallen, Texas
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