Medical Billing Specialist

Description

The Medical Billing Specialist is responsible for submitting medical claims to all accepted insurances companies. It is a position that is critical for the financial cycle of our company.  Medical billing requires attention to detail and experience with the electronic and paper systems used for billing medical claims.

Essential Duties and Responsibilities:

Include the following, other duties may be assigned

• Reviewing patient bills for accuracy and completeness, and obtaining any missing information
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Following up on unpaid claims within standard billing cycle timeframe
• Checking each insurance payment for accuracy and compliance with contract discount
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances
• Researching and appealing denied claims
• Updating billing software with rate changes
• Posting insurance payments and transferring balance to the appropriate payor.
• Posting patient payments
• Sending patients balance statements
• Following up on unpaid self-pay balances via phone call, patient letter and collection agency if applicable.
• Obtaining prior authorization as needed for office visits and sleep studies
• Verifying Insurances requirements such as prior authorizations, and limitations and patient responsibilities for visits or sleep studies.
• Ensures understanding of standards of performance, compliance with regulation, policy and procedure, and appropriate use of resources.
• Maintains knowledge of industry rules and regulations and maintains competence appropriate for job requirement.
• Complies with company policies and procedures.
• Performs other duties as directed by the Practice Manager

Competencies:

To perform the job successfully, an individual should demonstrate the following competencies:

• Interpersonal Skills – Focuses on conflict resolution and seeks the highest degree of accountability.  Listens to others with empathy and without interrupting.  Ability to manage interpersonal conflicts among clients, families and others in a positive and constructive manner.
• Communication – Speaks clearly and professionally in positive or negative situations; writes clearly and informatively; listens and gets clarification; able to read and interpret written information.  Ability to recognize and direct information to the appropriate health care provider.

Qualifications

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education, Credentials, Certification, and/or Experience:

• High School Diploma or GED
• 1 years related experience and/or training in medical services related fields

Knowledge, Skills, and Abilities: 

• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
• Competent use of computer systems, software and 10 key calculators
• Familiarity with CPT and ICD-10 Coding
• Knowledge of medical terminology likely to be encounter in medical claims
• Maintain patient confidentiality as per the Health Insurance Portability and accountability Act of 1996 HIPAA
• Strong verbal and written communication skills
• Good organizational skills

Working Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The majority of time is spent in a typical service-oriented work environment and requires almost constant use of the phone and computer. 

Salary : $16 - $18