Essential Job Functions:

• Performs eligibility verification and authorizations, and verifies all areas of client account for correct information, to ensure clean claim is billed. 
• Submits claims daily. 
• Follows up with insurance company on unpaid or rejected claims, and resolves issues and re-submits claims.
• Enters information daily into EMR including documenting attempts for resolving payment or claims with issues.
• Follows through with Appeals utilizing the payer specific process for timeliness.
• Timely completes all processes involving the Medicare Cost Report as directed.
• Obtains claims address and identification for new insurance companies and notifies billing supervisor immediately if any updates are necessary.
• Interacts with UR/Insurance Specialist staff to ensure the completion and/or correction of all billing paperwork for clean claim submission.
• Understands managed care authorizations and limits to coverage such as the number of visits.
• Downloads payment reports utilizing appropriate portals, clearinghouse and EOB's.
• Processes specific adjustments and reason codes and balances after every EOB.
• Monitors all manual entry where payment reports are unavailable.
• Balances day deposits and current client payments and reconciles daily for each. 
• Monitors unapplied payments for prompt resolution. 
• Identifies and corrects posting errors as they occur.
• Answers patient inquires on account status and charges, and answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc.
• Resolves patient complaints or explains why certain services are not covered.
• Works with patients to establish payment plan for past due accounts.
• Processes payments and refunds under the direction of the Patient Account Manager.
• Prepare and present reports on collection activities and progress.
• Performs miscellaneous job-related duties as assigned.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education and/or Experience:  Possession of a high school diploma and experience in collection, accounts receivable, and/or data entry required.

Knowledge/Skills/and Abilities: 

• Proven experience as a Collection Specialist or similar role.
• Knowledge of billing procedures and various collection techniques.
• Ability to communicate with clients and discuss overdue payments.
• Comfortable working with specific benchmarks and timelines.
• Knowledge of collection laws and regulations.
• Excellent communication and interpersonal skills.

• Ability to use various computer programs, including Microsoft Word, databases and Excel.
• Ability to prepare clear and concise reports.
• Ability to plan, organize and carry out work as assigned.

Necessary Special Requirements: Possession of a valid Florida driver's license, acceptable driving record, and proof of personal automobile insurance if required to drive an SMA vehicle and/or use a personal vehicle for SMA business. Complete State of Florida mandatory background screening prior to start of employment.  Complete SMA required training during the first six (6) months of employment and updated if required.

Physical: Mobility and ability to bend and reach during an 8-12 hour day. Able to lift minimum 10 pounds. Visual and auditory acuity sufficient to evaluate, intervene, treat, and record client health care needs. Fine motor skills for legible and accurate charting, daily correspondence and presentation, either manually or orally. Work endurance ability to work 8-12 hour shifts with a meal break, as possible. Routine 8-12 hour shifts. Hours and days off may vary. Extra hours may be required. Work assignment locations may vary.

Application: This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. It should not be used to limit the nature and extent of assignments such individuals may be given.