Billing Specialist

Job Summary:

The Billing Specialist will be responsible for managing and processing Primary and Secondary claims in a timely manner, ensuring accuracy and compliance with regulations. They are responsible for appropriate follow-up of transmitted or mailed medical claims. This role requires strong analytical skills and the ability to communicate effectively with various stakeholders.

Duties/Responsibilities:

• Review and process billing claims in a timely manner
• Ensure accuracy of claims submitted to insurance companies and other payers
• Resolve discrepancies and issues related to billing claims and insurance recoupment letters, and resolve accounts receivables to recover unpaid account balances
• Communicate with healthcare providers, insurance companies and patients regarding bill inquiries
• Maintain up-to-date knowledge of billing regulations and compliance requirements
• Prepare and submit reconsiderations and appeals for denied claims
• Collaborate and communicate effectively with other departments to improve processes
• Reviews billings to patients after insurance carriers have paid or denied claims to ensure prompt account balances
• Maintain detailed records of communications regarding financial status of patient accounts and collection efforts
• Sorts, files and scans all correspondence
• Maintains strict confidence of all patient accounts and complies with all company policies and HIPPA regulations
• Report on up-to-date encounter/claim status during all Revenue Cycle meetings
• All unpaid claims should have a follow-up call to the patient’s insurance company within 35-45 days of the date of service, and the first of each month thereafter
• Respond to all incoming emails within two business days
• Cross train with Clinic Biller handling like Health Plans
• All encounters listed in Revenue Cycle’s At Risk Claim Queue and Past Due Queue must a have a status update documented on the timeline each month
• Edit Failure, Late Charge Review, Pending Edit Claim and Technical Denial queues must be worked twice a week
• Performs other jobs and/or duties as requested by Director

Job Competencies:

• Excellent Customer Service and Communication Skills
• Strong Attention to Detail
• Must be a detail-oriented multitasker who works well under pressure

Required Skills/Abilities:

• Proven experience in billing, claims processing or a similar role
• Strong understanding of medical billing codes and insurance policies
• Strong analytical and problem-solving skills
• Effective communication and interpersonal skills, is empathic, listens for understanding and has pleasant telephone presentation skills
• Has excellent organizational skills. Organize and prioritize tasks to accomplish work
• Multitasks and manages time effectively
• Acquiring new skills, learning quickly, can effectively cope with change and shift gears comfortably
• Ability to work independently, supports other staff members by contributing, cooperating, sharing knowledge and working collaboratively with others and as part of a team

Education/Licensure Requirements:

• High School graduate or equivalent
• Ability to use personal computers and effectively navigate common software programs

Experience Requirements:

• 1-3 years medical billing preferred

Physical Requirements:

• Cannot have physical limitations that would prevent long periods of sitting
• Must be able to lift 10 pounds in weight