Medical Billing specialist

A Medical Billing Assistant in a primary care setting using MDOfficeManager in Clarksville, Indiana, would have several key responsibilities to ensure smooth billing processes and proper reimbursement for services rendered. Below is a detailed list of responsibilities specific to this role:

1. Patient Information Management

• Verify Patient Details: Collect and verify accurate demographic and insurance information from patients.
• Update Insurance Information: Ensure that all insurance details are current and accurate in MDOfficeManager.

2. Coding and Documentation

• ICD-10, CPT, and HCPCS Coding: Assign appropriate codes to diagnoses (ICD-10) and procedures/services (CPT/HCPCS) performed during patient visits.
• Accurate Documentation: Ensure that all procedures and treatments are properly documented and coded according to regulatory guidelines.
• Ensure Correct Billing: Validate that all billed services match the procedures provided and that no errors are made in coding.

3. Insurance Verification and Preauthorization

• Verify Insurance Coverage: Confirm insurance eligibility and benefits before patient appointments through MDOfficeManager or other tools.
• Obtain Preauthorizations: If needed, obtain preauthorization from insurance companies for procedures, tests, or treatments.

4. Claims Submission

• Generate Claims: Create and submit claims for services provided to primary care patients using MDOfficeManager’s claims module.
• Electronic Claim Submission: Submit claims electronically to insurance companies for faster processing and reimbursement.
• Insurance Follow-up: Monitor the status of claims and ensure timely follow-up with insurance providers.

5. Denied Claims and Appeals

• Investigate Denied Claims: Review any claims that have been denied by insurance companies, identify reasons for denial, and take corrective actions.
• Submit Appeals: Prepare and submit appeals for denied claims, ensuring that all necessary information and documentation is included.

6. Payment Posting and Reconciliation

• Post Insurance Payments: Accurately post payments received from insurance companies into the patient’s account within MDOfficeManager.
• Patient Payments: Post patient payments and manage any outstanding balances, ensuring that all payments are recorded accurately.
• Reconcile Accounts: Reconcile patient accounts to ensure all charges, payments, and adjustments are correctly entered.

7. Patient Communication

• Billing Inquiries: Answer patient questions regarding billing, insurance claims, and outstanding balances.
• Send Statements: Generate and send patient statements for outstanding balances.
• Assist with Payment Plans: Help patients set up payment plans when necessary and ensure timely payments.

8. Compliance and Regulations

• HIPAA Compliance: Ensure that all billing and patient information is handled in accordance with HIPAA regulations.
• Insurance Rules Compliance: Follow payer-specific billing rules and ensure compliance with insurance regulations.

9. Reporting and Financial Monitoring

• Accounts Receivable Management: Track and manage the aging of patient accounts, following up on unpaid balances and outstanding claims.
• Generate Financial Reports: Produce reports on practice revenue, outstanding claims, and account aging for the practice manager or physician.
• Track Denials: Keep track of claim denials and identify trends that need to be addressed.

10. Administrative and Support Tasks

• Coordinate with Clinical Staff: Work closely with doctors and clinical staff to ensure accurate documentation and timely submission of billing information.
• Maintain Patient Records: Ensure that patient records are updated regularly and that they comply with medical billing standards.
• Provide Billing Support: Assist with any other billing-related administrative tasks as required by the office manager or practice owner.

Skills and Tools Required

• MDOfficeManager Expertise: Proficiency in using MDOfficeManager's practice management and medical billing modules.
• Medical Billing Knowledge: Familiarity with ICD-10, CPT, and HCPCS coding, and the ability to apply them in primary care settings.
• Insurance and Payer Knowledge: Understanding of common insurance providers and their billing practices.
• Communication Skills: Ability to communicate clearly with patients and insurance companies regarding billing questions and issues.
• Attention to Detail: Ensuring all billing codes and documentation are accurate to prevent claim rejections.