Business Office

Reports to:

Business Office Supervisor/Manager

Organizational Peers:

Business Office Staff

Job Supervisory Responsibilities:


General Summary:

A nonexempt position responsible for the processing and collection of insurance payers.

Essential Job Responsibilities:
  1. Process electronic and paper claims using Athenahealth EHR
  2. Analyze outstanding balances to determine appropriate course of action.
  3. Trace and appeal underpaid, and/or erroneously paid or denies claims with appropriate documentation per payer requirements.
  4. Verify and adjust accounts according to payer or program specifications.
  5. Perform collection actions and resubmitting claims to insurances after corrections to minimize days in A/R.
  6. Accurately document claim issues.
  7. Prepare adjustments such as refunds, contractual differences, and write-offs for approval and processing.
  8. Audit, communicate and follow up with providers and staff to provide guidance in correcting errors related to denied or unpaid claims on continual basis.
  9. Assist staff with billing questions.
  10. Identify and resolve issues with patient/payer billing issues and complaints.
  11. Create new provider payer credentialing status and related claims.
  12. Review accounts for possible assignment to collections; make recommendations to Revenue Cycle Manager and prepare information for collection agency.
  13. Assigns uncollectable accounts to collection agency or attorney via clinic credit and collection policy.
  14. Review follow and report monthly, the status of delinquent accounts.
  15. Continually strive to promo0te and maintain exceptional internal and external customer service.
  16. Monitor payer websites for medical policy benefit changes. Communicate changes to supervisor and related staff.
  17. Review bulletins, newsletters and periodicals and attend workshop to stay abreast of current issues, trends and changes in laws and regulations governing claims, processing, coding and documentation.
  18. Provide suggestions to improve daily collections workflow and inefficiencies.
  19. Demonstrate working knowledge of ICD-10, CPT and HCPCS codes along with HIPAA laws.
  20. Comply with all written and stated company policies and procedures.
  21. Provide back up and support to team members as necessary.
  22. Work projects as assigned by management.
  23. Other duties as assigned.
Performance Requirements:


  1. Working knowledge of ICD-10, CPT and HIPAA laws.
  2. Knowledge of company medical billing/collection policies and procedures.
  3. Knowledge of legal and regulatory government provisions.
  4. Knowledge of business and communication software.


  1. Skill in establishing and maintaining positive, effective, internal and external working relationships.
  2. Skill in written and verbal communication and organization.


  1. Ability to multitask.
  2. Ability to accurately enter data and examine insurance documents.
  3. Ability to courteously work with patients, staff, and others.
  4. Ability to communicate well and interact in a positive manner with management, coworkers and payers effectively and clearly.

Position Competencies:

  1. Role model for organization’s core values
  2. Customer Service: Demonstrates the highest standards for friendly, courteous and caring interaction with patients, physicians, customers, and fellow employees.
  3. Analytical
  4. Organization and presentation abilities
  5. Professional presence
  6. Communication Demonstrates ability to accept and understand instructions, expresses self clearly and concisely.
  7. Adaptability/Flexibility Demonstrates the ability to cope with pressure, grasp new ideas and methods, and adjust responses to meet the changing work environment.
  8. Independence/initiative Demonstrates reliability, followthrough, ability to work with minimum supervision, and desire and ability to accept additional responsibility.
  9. Confidentiality
  10. Emotional Intelligence Maintain basic emotional and social competencies to include self-awareness, self-regulation, motivation, empathy, and social skills.
Job Qualifications:

Equipment operated: standard office equipment including computers, faxes, copiers, printers, telephones,etc.

Education/Experience:  High school diploma or equivalent. Some college, knowledge of medical terminology, system and ICD-10 preferred. Minimum of two years medical collections insurance experience preferred.

Physical: Position is in a well-lighted office environment and involves sitting approximately 90 percent of the day, walking or standing the remainder.