Billing Claims Specialist

Billing Claims Specialist – Job Description

About Reliable Respiratory

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.

Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.

Job Purpose

The Claims Specialist focuses on claims and procurement of authorizations and medical documentation to ensure Reliable is reimbursed in accordance with the procedures provided. This position reports to the Billing Manager, but will perform duties that pertain to customer service, documentation retrieval, medical billing and coding, and reimbursement. The primary purpose of this position is to identify reasons for claim denials and take all corrective action to resubmit the claim and obtain full reimbursement for the services rendered. Additional duties include:

• Review claims for denied procedures, identify issues, and take appropriate action to correct issue, resubmit claim, and procure maximum reimbursement for specific service. Duties include obtaining authorization, collecting medical documentation directly from facilities, and working with payers and provider services.
• Organize and report back denial trends to Management to implement measures to improve claim health and reduce payer AR times. Create and/or update written material and documentation related to insurance procedures and programs (i.e., insurance guidelines and processes and procedures).
• Assist in reviewing and analyzing relevant organizational and payer data (i.e., reviews payments and denials of insurance and communicates when changes need to be made for payment and profit margins)
• Develop and implement a system for working denials, ranging from dollar value to payor specialization, to age of invoice
• Issue invoices and bills and send them to customers through various channels (mail, e-mail etc.)
• Receive payments through various methods (cash, online payments etc.) and check for credibility.
• Answer questions and handle complaints from customers and payors regarding claims
• Reconcile deposits and invoices posted.

Basic Qualifications

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• Bachelor’s Degree required
• At least 2 years of medical billing, coding, reimbursement or health insurance experience preferred

Required Skills

• Strong health insurance knowledge of New England payers and Massachusetts ACO plans
• Proficient in obtaining authorizations in the most efficient manner (portal, fax form, phone in submission)
• Ability to learn Billing functions and be adaptable to the needs of the position.
• Strong interdepartmental communication
• Effective and professional verbal and written communication abilities
• Professional computer experience (especially Microsoft Office Suite)
• Ability to investigate problems and make decisions independently.
• Strong analytical skills

Competencies

• Computer skills
• Interpersonal skills
• Product expertise
• Communication skills
• Results driven
• Conflict management
• Customer service
• Organizational skills

Work Environment & Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
• This role routinely uses standard office equipment such as computers, phones, and printers/scanners

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This job operates in a professional office environment
• The noise level in the work environment is usually moderate to loud

Direct Reports – None

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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