Sanford Careers

Job Summary 

The role of the Patient Collections Specialist is to ensure accurate billing, timely submission of electronic/paper claims, monitoring claim status, researching rejections, and posting adjustments related account activities.  

Role and Responsibilities 

• Obtains billing data and census data for clients at all locations and levels of care. 
• Enters new client and payor date from EMR to billing system for Lafayette Medical Specialists.  
• Enters billing data into database and transmits medical claims to insurance companies in a timely manner. 
• Adds and reviews charges to ensure they follow payer requirements specific to the level of care the patient is programming in. 
• Reconciles data between EMR system and billing system to ensure accuracy in diagnoses, insurance, level of care, and demographic information. 
• Communicates variances and discrepancies to appropriate departments prior to billing to ensure consistency across the board. 
• Monitors and utilizes the Clearinghouse for claim submission and denials. 
• Reviews and troubleshoots denials, invalid claims, rejections, and resubmissions, 
• Makes notes in system pertaining to claim corrections, deletions, and mailed/faxed claims. 
• Audits claims billed daily. Audits charts in the billing system, updating/correcting as needed. 
• Collaborates with other team members to ensure an efficient month end closing. 
• Collaborates with other staff/team members to ensure accurate clean claims are be submitted. 
• Assists with the development of billing policies and procedures and ensures daily performance is conducted in a manner consistent with overall department protocol, compliance with Federal, State and payor regulations, guidelines, and requirements. 
• Protects patients’ rights by maintaining confidentiality of medical, personal, and financial information. 
• Adheres to established professional code of ethics and standards of practice to promote the best interest of the clients and company. 
• Adheres to established Code of Ethics, Standards of Practice, and employee handbook.  
• Participates in staff development and training, including staff meetings, in-service trainings and annual trainings required by Sanford Behavioral Health on a timely basis.  
• Possess a positive attitude to enhance a cooperative and energetic work environment.  
• Performs other duties as assigned. 

Qualifications and Education Requirements 

• Associate degree (AA or AS) or equivalent from two-year college or technical school; or two years related billing experience and/or training; or equivalent combination of education and experience, required. 
• Experience with Substance Abuse and Mental Health CPT, HCPCS, and ICD 10 codes, preferred. 

Knowledge/Skills/Abilities 

• Ability to read and interpret insurance provider manuals and documents related to billing requirements and procedure manuals. 
• Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. 
• Knowledge of EMR software, Excel, Word, and Clearinghouse software.   
• Excellent communication and organizational skills, self-motivated, critical thinker, and good decision-making abilities. 
• Ability to research issues as needed, staying abreast of changes with carrier rules and distribute the information within the agency. 
• Ability to maintain strict confidentiality on all client records and business-related records, as required under HIPAA guidelines. 
• Ability to work within a team setting and create an environment where all are valued and work together cohesively.  
• Knowledge of behavioral health and medical terminology. 
• Demonstrates professional behavior reflective of Sanford’s Mission Statement, Philosophy, and Values. 

Physical Requirements 

• Prolonged periods of sitting at a desk and working on a computer. 
• Must be able to lift 15 pounds. 
• Must be able to perform repetitive tasks such as typing for extended periods of time. 
• Must be able to clearly express and exchange ideas by means of spoken words to impart oral information to employees or others accurately or quickly, engaging in sometimes lengthy conversations or presentations. 
• Must be able to ascend and descend stairs daily.  
• Must be able to seize, hold, grasp, turn or otherwise work with your hand or hands. 
• Must be able to perceive sound by ear to interpret oral information from employees or others accurately or quickly. 
• Work will be performed in an office environment with fluctuating temperatures. 

ADA Disclaimer 

The employee must be able to perform the essential functions of the position adequately.  If requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. All requests for accommodations must be made to the Human Resource Department in writing.