Lead Medical Billing Specialist

Job Summary
Responsible for overseeing the timely and accurate billing of services provided and processing accounts receivable following the guidelines outlined in Northeast Wisconsin Retina Associates policies and procedures.

Responsibilities

• Providers leadership to a group of billing specialists, ensuring equitable distribution of daily duties.
• Facilitates billing of professional services rendered, following all government regulations and payer rules to promote clean claims utilizing both electronic and paper formats.
• Reviews complex medical charts to determine appropriate codes for charges and services incurred to assure maximum reimbursement.
• Posts insurance payments and follows-up on non-payment, denials, additional information requests, and appeals. Assisted billing team to resolve complex payment discrepancies.
• Coordinates with Billing Manager in monitoring payer policies to detect potential claim processing errors, authorization requirements, Step Therapy and other coverage restrictions.
• Assists clinical team in obtaining authorization per payer policy.
• Monitors insurance outstanding claims report and assists billing team with claim resolution.
• Tracks claims processing issues and provides routine updates on status to the Billing Manager.
• Ensures correct application of patient payments and follow up to reconcile accounts.
• Sets up refund requests and process refunds per NEWR overpayment policy.
• Answers patient questions regarding bills and insurance claims.
• Upon request, provides cost estimates, sets up payment plans, and takes payments over the phone.
• Interact with patients understanding their needs, provide information with patience and compassion to ensure a positive experience with our clinic.
• Manage sensitive information with discretion (HIPAA).
• Convey information clearly and effectively to internal and external customers.
• Collaborate with physicians, management team, technicians, and front office staff professionally.
• Assists billing manager with month end financial close
• Stands in for the billing manager as needed to ensure proper coverage
• Preparation and reconciliation of Daily deposits.
• Process medical record requests.
• Adjudicate Financial Hardship application.
• Cross coverage when needed.
• Miscellaneous duties as assigned.

Requirements

• Certification as a procedural coder or as an Ophthalmic Coding Specialist (OCS) or Ophthalmic Coding Retina Specialist (OCRS) preferred.
• High School diploma or equivalent required.
• Three to four years of supervisory experience and directly related experience involving physician billing procedures.
• Computer skills include Microsoft Office, Adobe Acrobat, and utilization of Payer portal platforms.

Job Type: Full-time

Pay: $21.00 - $25.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Experience:

• Medical Billing: 2 years (Preferred)

Ability to Relocate:

• Appleton, WI 54914: Relocate before starting work (Required)

Work Location: In person

Salary : $21 - $25