What are the responsibilities and job description for the Medical Billing Specialist position at Janigian Retina Associates?
Company Description
Janigian Retina Associates provides compassionate, expert care for individuals coping with diseases of the retina, macula, and vitreous. Our dedicated team ensures the highest standard of treatment for patients and their families. We are committed to delivering specialized eye care with a focus on patient well-being and health outcomes.
Role Description
This is a full-time on-site role for a Medical Biller located in Providence County, RI. The Medical Biller will be responsible for processing medical claims, managing insurance and Medicare claims, handling denials, and performing data entry of patient information. The daily tasks also include verifying patient insurance coverage, coding medical services using ICD-10 coding, and ensuring accurate billing and timely reimbursement.
Responsibilities
- Process and submit medical billing claims accurately and efficiently.
- Maintain current knowledge of federal and state regulations regarding medical billing practices.
- Review patient records to ensure all services are billed correctly.
- Manage accounts receivable and follow up on outstanding collections.
- Utilize coding systems such as ICD-10 for accurate billing.
- Maintain up-to-date knowledge of medical terminology and billing regulations.
- Collaborate with healthcare providers to resolve any billing discrepancies.
- Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years.
- Conduct AR Follow-up both on front end scrubs and back end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
- Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
- Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
- Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
- Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
- Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
- Candidate must be able to report and communicate issues and trends.
- Meet or exceed daily productivity benchmarks.
Requirements
- Knowledge of Medical Terminology
- Experience in handling Denials, Insurance claims and Collections
- Proficiency in ICD-10 coding
- Understanding of Medicare billing processes
- Excellent organizational and communication skills
- Ability to work independently and efficiently in an on-site environment
- Previous experience in a similar role is required.
- Solid background in A/R and overall Revenue Cycle policies and procedures.
- Bachelor’s degree or relevant certification in Medical Billing or a related field
