What are the responsibilities and job description for the Billing and Revenue Specialist position at Lytle Medical Technologies?
Job Overview
This position is responsible for the optimal payment of claims from insurers. Primary duties include Insurance verification, obtaining authorization, submitting clean claims to insurers, follow up on unpaid, underpaid or denied claims. This position is also responsible for providing claim support to ensure maximum reimbursement from insurance plans and patients.
Duties
Responsibilities of the Billing and Revenue Specialist :
Review patient charts and billing system to ensure accurate data is present that will achieve maximum claim reimbursement.
Submit clean claims utilizing Brightree Software or in some cases Speedy Claims; Implement and maintain competency with Software tools to maximize the effectiveness of the billing process.
Accurately follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory requirements.
Review and analyze claim failures on front-end claim edits.
Follow up on unpaid or underpaid claims for maximum reimbursement.
Post insurance payments and review automated invoices for accuracy prior to releasing from billing software while reviewing for possible refunds, underpayments, etc.
Prepare documents for medical records requests.
Prioritize claims based on Timely Filing limits as directed by management.
Meet with Supervisor to review chart follow up database, systemic issues, and other concerns that prevent a streamlined and effective billing process.
Assist the Patient Benefit and Billing Manager and Billing Associates with billing and claims related tasks.
Answer and resolve patient insurance and billing calls and concerns.
Maintain and update billing software price tables in accordance with contracted plan fee schedules.
Coordinate and prepare insurance appeals.
Review payer trend reports for payments, denials, and reductions.
Analyze and respond to authorization denials.
Review explanation of benefits for appeal opportunities.
General Responsibilities :
Cooperate with other members of management in supporting long-range strategic and operational plans.
Support the mission, values, and standards of Lytle Medical Technologies.
Provide reports for those activities you are responsible for and report those to the Supervisor.
Assist in ensuring ongoing compliance with all laws and regulations; assist in ensuring that the Company meets or exceeds accreditation standards; and assist in the implementation of ‘’best practices’’ in all Company activities.
Work with Company’s Suppliers and Business Partners to ensure all required information is transferred on a timely and accurate basis.
Work with Company’s clients and patients to answer questions and assist in business and patient care matters.
Participate in membership activities of professional and industry organizations, if applicable.
Participate in surveys conducted by authorized inspection agencies.
Work with all company personnel, patients, and Physician offices to ensure all patients are provided outstanding service and care.
Participate in the Company’s Performance Management program as requested by the Performance Management Coordinator.
Pursue continuing education programs appropriate to job responsibilities.
Participate in Company Committees when requested.
Represent the Company in a professional and courteous manner in all interactions with Clients and Patients.
Report Equipment hazards and / or product incidents as required in accordance with company policy.
Perform other duties as assigned by Supervisor and / or the leadership team.
Minimum Qualifications
Must have a passion and commitment to customer service including excellent phone skills.
Detail oriented and organized to maintain consistently accurate records.
Effective interpersonal, time management and organizational skills.
Skilled in data analysis, problem definition, and problem solving and recurrence prevention
Self directed but focused on teamwork.
Experience with Microsoft Word, Excel, & Windows; Google Docs, Sheets, Gmail & Chrome.
One year of Home Medical experience is preferred.
High School Diploma.
Experience in HME or health industry. Must have knowledge of Medical Insurance Authorization.
Experience in DME Workers Comp authorization is desirable.
Knowledge and proficiency with ICD-10 and HCPCS billing codes.
Knowledge of Medicare, Private and Commercial Insurance Billing Requirements and Policies.
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