Billing Specialist I

Essential Functions

• Initiates Prior Authorization submissions and completes all follow ups for all insurance Payors including Medicare Advantage, Medicaid's, HMO, PPO, and Commercial until the case has reached a determination.
• Compiles pre-certification information to submit prior authorization requests via outbound phone calls and/or web-based sites (familiarity with payors).
• Performs regular follow-up calls with insurance companies to check status of prior authorization request. Logs approval in database.
• Conducts outbound and/or inbound calls to patients, doctor's offices, insurance companies as necessary or required to complete tasks.
• Ensures proper documentation is received and recorded before processing additional supplies to patients, per compliance guidelines.
• Ensures accurate entry and update of changes as requested by physicians and/or patients.
• Maintains working knowledge of billing guidelines and resources for Medicare and Private Insurances.
• Recognizes and reviews billed orders to effectively request authorization for upcoming refills.
• Researches, follows up, and resolves all open/pending Authorizations in a timely manner.
• Develops and maintains knowledge of all products and services offered by the company.
• Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.
• Maintains accurate and detailed notes in the company system.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback as to improve processes and policies.
• Attends all department, team, and company meetings as required.
• Appropriately routes incoming calls when necessary.
• Meets patient service quality standards.
• Embraces and exemplifies ADS core values:
• We grow together
• We care
• We obsess over the customer experience
• We commit
• We WOW!
• May perform any additional responsibilities or special projects as required.
• Duties and responsibilities may be subject to change based upon the needs of the department.
  

Requirements

• High School diploma or equivalent
• Knowledge of insurance verification and/or authorization, billing, and processing claims
• Basic knowledge of billing guidelines and resources for Medicare and Private insurance
• Basic knowledge of insurance portals; familiarity with a variety of medical and/or insurance terms or practices
• Proficiency in basic math and business calculations
• Working knowledge of computer/data entry with the ability to learn new systems
• Basic level of MS Office proficiency
  

Expected Competencies

• Friendly, professional, and effective communications skills; able to calmly present solutions in challenging situations
• Ability to work well in a team environment that promotes inclusiveness and communication among team members
• Effective interpersonal skills
• Clear diction and knowledge of the English , both written and verbal
• Detail oriented, highly organized; able to work at a fast, productive pace
• Service- and aptitude to resolve insurance and/or patient matters
• Self-directed accountability and reliability
• Cultural competence
  

Physical Demands

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable employees with disabilities to perform the essential functions.

While performing the responsibilities of the job, the employee is required to remain in a stationary position most of the time (stand or sit). While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is frequently required to stand, walk and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

Other Requirements

• Candidates must successfully pass a background check.
• Candidates must be able to provide proof of eligibility to work in the United States.