job description

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Job Summary:

The Medical Billing Specialist is responsible for processing all third-party primary and secondary insurance claims for ancillary professional services. The incumbent in this position performs insurance billing, account follow-up, and collections on all outstanding balances.

Essential Functions & Responsibilities:

• Reviews third party payer work queues to locate accounts for billing. Resolves edits related to billing and claim edit work queues to ensure claims are billed accurately.
• Submits claims to the clearing house, reconciles submitted claims, identifies those that rejected, and addresses any remaining issues with submission.
• Resolves claims denials as they appear.
• Researches/refunds/resolves insurance credit balances.
• Identifies, analyzes, and escalates trends impacting reimbursement.
• Contacts third party payors and patients to expedite and maximize payment of insurance medical claims.
• Identifies claims processing issues and notifies leadership to avoid further delay in claims processing.
• Collaborates with management to reduce aging of accounts by providing verbal and written communication.
• Documents clear, concise, and complete follow up notes in system for each account worked. Visually proofreads and monitors work output to ensure accounts are completed.
• Remains current on collection procedures of various payors and specialty departments.
• Participates in educational activities and attends team meetings. Assists with knowledge sharing, payor and department training, and provides support to other team members.
• Demonstrates expertise of all payors, including Medicaid, commercial payors, and applicable department’s revenue cycle operations. Ensures protection of private health and personal information. Adheres to all HIPAA and PCIO compliance regulations.
• Performs other duties as assigned.

Qualifications:

• High school diploma or equivalent required.
• Minimum of 2 years’ billing experience required, preferably Home health care and in a multi-specialty physician practice.
• Knowledge of professional CPT and diagnosis codes preferred.
• Certified Revenue Cycle Specialist (CRCS-I) or related industry certification preferred.

Job Type: Full-time

Pay: $17.47 - $21.03 per hour

Schedule:

• Day shift

Experience:

• ICD-10: 1 year (Required)

Work Location: In person