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.

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.