Medical Billing Specialist - Specialty

Job Purpose:

Maintenance of account which includes AR follow up, payment posting & balancing, filing claims & managing rejections, as well as generating statements and receiving inbound patient calls.

Responsibilities:

• Contact insurance companies regarding claims.

• Process and follow up on appeals to insurance companies.

• Answer patient inquiries.

• Filing of all claims.

• Post and balance payments, if applicable

• Maintain productivity standards and goals set by the department and/or manager.

• Maintain standard quality measures and goals.

• Proactively resolve any cash restraining issues by seeking out and identifying trends in each facility’s AR

• Follows up on non-responded and denied insurance claims for all third-party carriers (Self-Pay, Private, HMO/PPO and Gov’t payers).

• Processes insurance/patient correspondence with insurance carriers to resolve adjudication issues.

• Resolve any issues affecting reimbursement and/or adjudication in a timely manner

• Available to patients and clinical departments to address specific payer issue

• Provide feedback to Revenue Cycle Management based on the monthly review of AR

• Maintain strict confidentiality within medical practice and HIPAA compliance.

• Attend Meetings as required and/or participate in various committees as required

• Other duties as assigned by, Manager, Director, VP RCM.

Required Skills:

• High school diploma/GED

• Preferably two years’ prior experience in physician professional billing (Managed Care, Commercial and or CMS Part B claims adjudication, including but not limited to:

- Explanation of Benefit forms (EOB)

- Credit balances (discounts and refunds)

- Insurance carrier billing requirements

- Collections

- Familiarity of payer provider enrollment

Core Competencies:

Accountability and Self-Management

• Must be detail-oriented and organized

• A self – starter capable of tracking to deadlines and meeting goals with little supervision required

• A high level of analytical and problem solving skills is expected

Teamwork and Leadership

• Ability to work autonomously and as a team player, and display some leadership qualities

Communication

• Excellent communication, customer service, and organizational skills

• Strong verbal and written communications is desirable;

Innovation and Problem Solving

• Attention to detail and moderate analytical and problem solving skills is expected

Computer Skills

• Must possess general office skills and computer knowledge

• Strong working knowledge of the Aprima EPM practice management system and/or GE Centricity Business system and coordinating modules, is preferred

• MS Excel Spreadsheet software, MS Word Processing software and MS Power Point software.

Physical Demands:

• May require sitting for long periods of time; also, stooping, bending, and reaching for files and supplies.

• Requires manual dexterity sufficient to operate a computer keyboard, answer a telephone, and run a copier and other office equipment as necessary.

• Employee must participate to help maintain the desirable work environment created by the management and company officials.