Overview

The Billing Specialist I is responsible for all aspects of insurance follow up and collections, including making telephone calls and accessing payer websites.

Responsibilities

ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.

• Bill both electronically and manually, as needed, and use all technology available to produce clean claims.
• Interpret claims processing reports and apply information to produce clean claims.
• Maintain current knowledge of regulatory billing requirements.
• Make changes to demographic information as necessary in order to produce a clean claim.
• Post patient payments and follow up on unpaid accounts.
• Patient refunds as necessary/
• Meet or exceed productivity standards in the completion of daily assignments and accurate production.
• Analyze coding to ensure proper billing of claim. Effective with claims follow up, denial posting, processing and appeals.
• Request and attach required clinical documentation in accordance with third party requirements.
• Service accounts in priority of importance, independently billing accounts with understanding of all applicable insurance and CMS regulations. Prioritize work to maximum turnaround time.
• Post and interpret EOBs, resubmit and/or appeal underpaid or denied claims.
• Ability to assign CPT/ICD-9/10 and HCPCS codes from surgical/progress note.
• Handling incoming inquiries from patients and insurance companies.
• Attention to detail with the ability to identify/resolve problems and document the outcome.
• Regular and reliable attendance.
• Perform other duties as assigned.

Qualifications

Education: High school diploma or equivalent

Experience: 0-3 years’ experience in a dermatology private practice or physician’s office setting with responsibility for billing major insurances, other third-party payors and self-pay using a centralized computer-based patient admission or billing system. One (1) years’ experience in electronic billing.

Technology Applications: One (1) year experience in electronic billing. eCW preferred. Proficient in Microsoft Applications.

Role Specific Knowledge:

• Medical terminology
• HIPAA privacy laws

PHYSICAL AND MENTAL DEMANDS:

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle or fell objects, tools, or controls; reach with hands and arms; climb stairs; balance, stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift, push, pull and/or move up to 20 pounds. Repetitive motion of upper body required for extended use of computer. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.