Business Office Specialist II - FT - Days - Billing and Collections

Clerical, Administrative &Registration Edinburg, Texas


Position at DHR Health


This position is responsible for business office activities which include collection of accounts receivable, patient billing, customer service, cashiering, refunds/recoupment's, appeals, and provides refunds for services to patients and third party payers as needed.  This position requires that at least three (3) of the functions above are able to be performed.



  • High School Diploma/GED is required
  • Comprehensive knowledge of healthcare reimbursement.
  • Understands medical terminology
  • Familiarity with EOB’s and RA’s
  • Knowledge of Microsoft Office suite, working knowledge of Excel required.
  • Excellent Customer Service
  • Good written and verbal communication skills required
  • Must be able to multi-task
  • Ability to read, write and speak English
  • Ability to communicate clearly and concisely with all levels of management
  • Bilingual – English/Spanish, preferred



  • Previous healthcare experience (2-3 yrs.) required, hospital experience preferred.
  • Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
  • Establishes and maintains long-term customer relationships, building rapport with other department staff
  • Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
  • Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Medical Terminology, ICD-9, ICD – 10, Codes, CPT Codes, HCPCS code, Modifier knowledge required.
  • Ability to use the internet to obtain information from Third Party Payers or other sources is required.
  • Requires working with minimal to moderate interruptions



  • Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
  • Receives incoming and outgoing calls from patients and informs them of their balance due after insurance has paid.
  • Assists patients and carriers with questions and concerns regarding the billing and collections of accounts.
  • Obtains copies of required insurance identification cards, as needed.
  • Works special projects as assigned.
  • Assist with posting payments and identifying correct I-plan
  • Daily download and review report of patient balance for statement release.
  • Update address on return mail as needed
  • Review RAs and EOB’s total charges, amount of insurance payment and balance owed by patient or responsible party.
  • Explains hospital payment policies and collects patient balance due and writes receipts for all payments collected.
  • Performs daily reconciliation of petty cash.
  • Download and post electronic remits and apply payments and adjustments as per I-plan.
  • Make deposits to the bank.
  • Researches credit balances for accurate processing of refunds due to over payments and/or allowances requiring a correction in a timely manner.
  • Prepares credit worksheet and processes all transactions required to request refund checks or to correct account balances.
  • Transfers patient credit balances to outstanding accounts according to hospital policy and procedure, and prepares letters of explanation concerning refund issued to third party payers and patients.
  • Researches and prepares quarterly Medicare credit report.
  • Responds to all mail and phone calls concerning credit balances and refunds checks.
  • Completes provider applications for payers
  • Follows-up accounts on assigned ATB and/or custom reports and contacts insurance carrier for payment and/or recoupment’s.
  • Enter appropriate mnemonic in the notes tab
  • Utilizes tickler, when requesting additional information from other co-workers or departments
  • Responds to correspondence from insurance carriers in a timely manner.
  • Determines financial status and refers patient for financial screening as appropriate
  • Ability to identify accounts that need insurance billing or rebilling
  • Adheres to collection tips booklet when contacting insurance carrier.
  • Demonstrates proficiency in billing and follow up of Medicare, Medicaid claims on-line or through billing software
  • Proficient in accessing information needed from Cerner and AX document imaging software.
  • Request copies of medical records from HIM for any paper records
  • Ability to access medical records from Cerner system to appeal claims with carriers.
  • Enter and maintain appealed accounts through the variable data system.
  • Maintain PMMC software system for carrier over and under payments to facility.
  • Create appeal letters with appropriate details of appeal
  • Select correct adjustment codes on adjustment form to appropriately document reason for adjustment
  • Complete adjustment form appropriately with the correct dollar amount assigned to the adjustment code
  • Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
  • Other duties as assigned.



CFO …. Director …. Manager ….. Supervisor