Medical Billing Specialist

Job Description

Job Description

Overview

The Medical Billing Specialist plays a critical role in the healthcare economy by ensuring that healthcare providers are accurately reimbursed for their services. This role involves the management of claims submissions, processing, and follow-up with insurers. A Medical Billing Specialist is expected to maintain meticulous records, understand complex billing codes, and navigate ever-evolving insurance compliance regulations. They serve as a key liaison between the healthcare provider, the patient, and insurance companies, effectively resolving any billing discrepancies. Their expertise ensures that the financial operations of healthcare facilities run smoothly, contributing significantly to the overall operational efficiency of the organization.

Key Responsibilities

• Maintain and update patient billing information.
• Prepare and submit claims to insurance companies.
• Review and interpret medical charts to connect diagnoses and procedures with the correct billing codes.
• Follow up on denied claims, appealing when necessary for resolution.
• Communicate effectively with healthcare providers and insurance representatives.
• Generate monthly statements and manage accounts receivable.
• Verify patient insurance eligibility and benefits prior to services.
• Research and resolve patient billing inquiries and discrepancies.
• Ensure compliance with federal and state regulations affecting healthcare billing practices.
• Utilize billing software and electronic health record (EHR) systems efficiently.
• Track payments and maintain accurate records of accounts.
• Assist in audits by maintaining clear documentation of billing processes and transactions.
• Up-to-date knowledge of billing codes (CPT, ICD-10) and insurance policies.
• Participate in continuing education to stay informed about changes in billing practices.
• Implement best practices in billing procedures to enhance workflow efficiency.

Required Qualifications