Medical Billing Specialist

Finance

: Bill Lead and C.F.O.

Performs the duties and functions necessary to generate and submit patient care billing to payors.

• Prepare, review, and transmit claims from providers using billing software, including electronic and paper claims within of being locked.
• Direct data enter all secondary claims and EOB’s in Mihms Portal, daily.
• Work with provider and insurance companies to get a claim processed and paid as identified.
• Confirm codes are billable and within SCRFHC Fee Schedule when creating claims.
• Research and appeal denied claims, as identified.
• Identify and bill secondary and tertiary claims, daily.
• Follow up on unpaid claims (Aging) weekly.
• Research denied claims information in the EMR to update claims with accurate insurance information for patients as identified.
• Assure CPT/HCPC codes and modifiers are appropriate to maximize reimbursement.
• Review aging (at a minimum) bi-weekly.
• Know ICD10 and CPT Coding.
• Review electronic health record for documentation and coding when necessary.

• Import daily ERA and EFT payments.
• Check insurance payments for accuracy and compliance with contract discount.
• Post payments within one week or sooner when possible.
• Review patient statements for accuracy and completeness and obtain missing information.
• Telephone insurance companies regarding any discrepancy in payments when identified.
• Create daily Insurance, patient payment deposit slips and copy all checks for payment posting.

• Communicate with Billing Lead when issues arise with provider credentialing with insurance companies.
• Meet with Billing Lead weekly to discuss workflow.
• Review patient statements returned if undeliverable by USPS.
• Answer all patient or insurance telephone inquiries pertaining to assigned accounts within 24 hours.
• Knowledge of HIPAA and Privacy Notices.
• Support the PSR team in verifying insurance information for patient visits and assuring entry is accurate.
• Verify eligibility for treatment and procedures on denied claims.
• Review and retrieve daily insurance payments from mail – back up to FA.
• Deliver and retrieve bank deposits – back up to FA.
• Assure open communication with other departments.
• Set up patient payment plans and work collections accounts.

Develops and sustains positive working relationships with SCRFHC team.

1. Minimum 2 years post-secondary school degree or certificate program.

2-3 years relevant work experience preferred in a healthcare setting

Job Type: Full-time

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to Relocate:

• Princeton, ME 04668: Relocate before starting work (Required)

Work Location: Hybrid remote in Princeton, ME 04668