Held Bill Specialist_PAP Biller na None

Summary of Position:  The Held Bill Specialist is responsible for performing insurance verification to ensure that patients’ health care benefits cover the required equipment, completion of the certificate of medical necessity and authorizations for billing.  

Education: High School Diploma or Equivalent

Experience: Prior healthcare billing is helpful; familiarity with insurance rules and regulations preferred; Medicaid experience is a plus

Skills: Good organization and time management, Detail oriented, Good Written and Verbal Skills, Good interpersonal and communication skills, ability to work alone as well as a team, computer knowledge equivalent to position, such as Microsoft Office

Requirements: None

Physical: Regularly required to sit and use hands to finger, handle and feel.  Regularly required to talk or hear and see.  

Essential Duties and Responsibilities:

1. Provide accurate, real-time validation of patients’ insurance and benefit coverage. 
2. Work with insurance provider to clearly identify the patient’s insurance coverage and financial obligations are valid and correct, and ensure the provider records match the patient information.
3. Print Certificate of Medical Necessity forms (CMN’s), physician orders, and obtain reauthorizations for all locations with information from order entry or clinical services.  Coordinate via mail, or fax to physician’s office, or appropriate contact.
4. Log CMN’s, physician’s orders and re-authorizations, verifying completeness and accuracy.
5. Forward CMN’s, physician’s orders and authorizations to medical records for network scanning.
6. Follow up on CMN’s and authorizations as necessary for appropriate completion of billing process.
7. Work with Branch Managers and billing staff to determine appropriate method of claim submission base on completed physician’s orders, CMN’s, and authorizations information.
8. Stay familiar with reimbursement guidelines, attend meetings and review reference publications/updates as needed.
9. Run bi-weekly reports to assist in obtaining necessary renewals in a timely manner to assure minimal disruption in services and payment.
10. Review CMN and authorization on-hold report daily.   
11. Investigate and resolve claims that have been pending for more than 60 days.
12. Maintain confidentiality in patient matters