Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution. 

Functions 

• Promote the mission, vision, and values of the organization 

• Import charges from queues in a timely manner and append modifiers or any required information for claim transmission  

•  Review daily accounts that are ready to be billed in Waystar from Meditech 

•  Initiate correction on all claims with errors by the designated time 

• Follow up on any correspondence that may have been received on that day or the previous day 

•  Cross train on billing all lines of business to the different payers 

•  Pull listing of all accounts assigned to be follow up by specific payer 

•  Diagnostic and procedural coding 

Follow-Up Responsibilities 

• Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies. 

• Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims. 

• Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts. 

• Maintain accounts receivable detail of their accounts through tasking. 

• Maintains standards per payer for percentage accounts >90 days. 

• Works minimum standard number of accounts per payer per day. 

• Meets or exceeds collection goals by payer each month. 

• Works all assigned accounts as assigned, depending on balance. 

• Complete appeals as required. 

• Participates in educational activities and attends monthly department staff meetings. 

• Maintains confidentiality: adheres to all HIPAA guidelines/regulations. 

• Other duties as assigned from time to time. 

• Attend educational activities and monthly department staff meetings 

• Perform other duties as assigned