Medical Billing Specialist

Position Overview:  

Join the compassionate team at Sugarloaf Medical, PC , and become an essential member of our medical billing department. We are seeking a detail oriented and efficient professional committed to facilitating accurate and timely billing processes. In this role, you will be instrumental in handling various aspects of billing, ensuring adherence to insurance guidelines, and maintaining accurate patient financial records.

Key Responsibilities:  

Insurance Billing:

• Verify Insurance: Confirm patient insurance coverage and benefits.
• Claim Submission: Prepare and submit claims to insurance companies.
• Payment Posting: Post insurance payments to patient accounts.
• Denial Management: Address and appeal denied insurance claims.

Patient Financial Management:

• Invoice Preparation: Generate and issue invoices to patients.
• Payment Processing: Post payments received from patients to their accounts.
• Financial Assistance: Assist patients with payment options and financial aid programs.
• Collections: Coordinate the collection process for overdue accounts.

Collections:

• Payment Arrangements: Establish payment plans with patients and monitor adherence.
• Delinquent Accounts: Manage overdue accounts and coordinate with collection agencies.

Billing Inquiries:

• Aid patients in understanding their benefits and cost sharing responsibilities.
• Resolve queries about balances and explain Explanation of Benefits (EOB) to patients.
• Handle and resolve both patient and insurance billing inquiries.

Administrative Duties:

• Reporting: Generate reports to check billing data for accuracy and completeness.
• Fee Management: Update fee schedules and billing rules as needed.
• Account Reconciliation: Conduct regular account reconciliations.

Insurance Credentialing:

• Physician Credentialing: Register new physicians with insurance companies.
• Practice Credentialing: Enroll the practice with new insurance plans.

Insurance Compliance:

• Ensure adherence to medical billing regulations and standards.

Quality Control:

• Maintain confidentiality of all billing and collection information.

Job Qualifications:

Educational Requirements:

Candidates should have completed the following educational program:

• Diploma or Certificate in Medical Billing and Coding.
• Associate's Degree in Health Information Management, or a related field
• Associate's Degree in Healthcare Administration, or a related field
• Associate's Degree in Medical Office Management, or a related field
• Bachelor's Degree in Healthcare Administration
• Bachelor's Degree in Business

Professional Certifications:

Candidates are expected to have one or more of the following certifications:

• Certified Professional Coder (CPC).
• Certified Medical Reimbursement Specialist (CMRS).

Mandatory Training and Certifications:

Applicants are required to have training and certification in the following areas:

• HIPAA (Health Insurance Portability and Accountability Act)
• OSHA (Occupational Safety and Health Administration)
• BLS (Basic Life Support)

Competencies and Experience

Medical Knowledge:

• Familiarity with Medical Fundamentals: Understanding of common medical terminology and anatomy.

Technical Proficiency:

• EMR Systems: Required experience with Electronic Medical Record (EMR) systems.
• Software Skills: Proficiency in Microsoft Word and Excel.
• Patient Management: Competence in patient scheduling and managing medical records.

Patient Care:

• Patient Privacy: Commitment to ensuring patient privacy and safeguarding Protected Health Information (PHI) in compliance with HIPAA and cybersecurity standards.
• Safety: Maintaining personal and workplace safety in accordance with OSHA standards.

Communication Skills:

• Verbal Communication: Strong communication skills and telephone etiquette.
• Written Communication: Effective written communication skills.

Organizational and Detail Oriented Skills:

• Multitasking and Precision: Proficiency in handling multiple tasks under pressure with attention to detail.

Relevant Experience:

We require a minimum of 2 years of experience as a Medical Biller, preferably in a primary care setting.

• Thorough knowledge of E/M coding guidelines and documentation requirements.
• Proficiency in ICD10, CPT, and HCPCS coding systems.