The Financial Services Specialist performs a variety of complex clerical and accounting functions for patient billing, including verification of invoice information, maintenance of third party billing records, and resolution of a variety of problems.

Description of Primary Responsibilities

Responsible for customer service:

• Provide necessary customer and support services to patients of Palms Medical Group (PMG) within his/her field of training in accordance with stated policies and procedures of PMG.
• Answer, screen and route telephone calls in a polite and professional manner.
• Answer the telephone within three (3) rings.
• Efficiently operate a multiline telephone (transferring, voicemail and que).
• Research and respond by telephone or in writing to patient inquiries regarding billing issues and claims.
• Know all PMG departments and services.

Responsible for insurance filing:

• File all insurance claims, including but not limited to worker’s comp, Medicare, Medicaid, private carriers and contractual arrangements in accordance with the policies and procedures of PMG.
• Responsible for identifying and investigating changes in reimbursement patterns on any carrier and reporting to the VP of Financial Services.
• Maintain files on claim forms and explanation of benefits
• Prepare and mail or electronically file private billing and verify accuracy, in accordance with the policies and procedures of PMG.
• Remain informed on guidelines for all insurance carrier types.

Responsible for billing:

• Process billing to patients and third-party reimbursement claims; maintains supporting documentation files and current patient addresses.
• Process patient statements, keys data, posts transactions and verifies accuracy of input to reports generated.
• Follow up on submitted claims, monitors unpaid claims, initiates tracers and resubmit claims as necessary.
• Receive and receipt cash items and third-party reimbursements; post and reconcile payments to patient ledgers.
• Review all receivable accounts and follow-up on outstanding balances, including unpaid claims in accordance with the policies and procedures of PMG.

Responsible for administrative duties:

• Read and adhere to the Accounting Policy Manual.
• Provide backup for front desk data entry to include: patient registration, visit entry, updates on billing information, etc.
• Responsible for qualifying and re-qualifying eligible patients in the sliding fee program and removing as appropriate; verifying and maintaining records in compliance with the policies and procedures of PMG.
• Be responsible for the collection reports and ensure letters go out in a timely manner.
• Participate in QA/QI and other meetings as directed by the VP of Financial Services.
• Perform MIS duties in the VP Financial Service’s absence: Daily, Monthly and Yearly reports.
• Provide the CFO with all reports requested, including, month end, provider productivity, depreciation, etc.
• Assist the CFO with data collection for UDS and grant applications.
• Assist with audits and surveys as directed by VP of Financial Services.
• Perform any other duty assigned by the VP of Financial Services, CFO or CEO to improve the efficiency of PMG.