Medical Billing Specialist

1 month ago

Stratford, United States Optimus Health Care Full time

COMPANY DESCRIPTION

OPTHC was founded in 1976 and is known as the largest provider of primary health care services in Southwestern Connecticut.  OPTHC is also among the most established health care providers in the state. This means they are clinically experienced, and deeply committed to the communities served, with services that include primary, dental, behavioral, and specialty health care.

Mission Statement:  

"OPTHC to be a lifelong healthcare partner, dedicated to achieving optimal wellness for the communities we serve."

Vision Statement:  

"A world where access to culturally sensitive, high-quality healthcare is always within reach.

also among the most established health care providers in the state. This means we are clinically experienced, and deeply committed to the communities we serve.

Range of services. With primary, dental, behavioral, and specialty health care, we can address many of the problems our patients experience."


POSITION SUMMARY

 

Responsible for performing all tasks related to the Billing, Cash posting, Follow-up, and Collections functions for Optimus Health Care.


ESSENTIAL FUNCTIONS & RESPONSIBILITIES

 

1. Research all information needed to complete billing processing including correction of prebilling errors to ensure compliance with regulatory guidelines.

2. Review of claim batches, making appropriate corrections for claims to be accepted by clearing house.

3. Post any corrections to charges to ensure integrity of account information.

4. Analyze billing reports to ensure proper billing procedures are followed based on federal and state rules and regulations.

5. File all claims on a daily basis (electronic claims and hard copy)

6. Run pre-billing and correct all errors at time of billing.

7. Post all cash payments received on a daily basis.

8. Research and resolve all collection related activities, including working through accounts receivables to maximize reimbursement.

9. Function as a liaison between patients and clinic staff on claims, billing questions or insurance related issues.

10. Trace errors, record adjustments to proper account and determine the appropriate destination of unidentified funds.

11. Respond to inquiries from agencies, insurance companies to assist in claim payment processing.

12. Effectively process all patient and third-party correspondence, including requests for copies of claims, statements and refunds.

13. Effectively process all legal documentation as it relates to patient accounts.

14. Act as a resource to Physicians, Administrators and patients regarding health insurance claim policies, procedures and requirements.

15. Provide support to the Billing department management team on various areas of patient billing research and analysis.

16. Work on various projects as assigned by the billing department management team.

17. Research, trouble-shoot Accounts receivable reports and rejections, process appeals where appropriate, and make recommendation for write offs.

18. Is responsible for accurate and timely completion of job assignments.

 

ADDITIONAL GENERAL REQUIREMENTS


Professional positive attitude, vision, understanding of customer service principals, trustworthiness, and excellent interpersonal skills to successfully accomplish tasks necessary to meet high standards of ethical and social responsibility required by this position.

 

JOB QUALIFICATIONS/REQUIREMENTS

 

EDUCATION: High School Diploma. Certified in medical coding (CPT4 and ICD9/ICD10), helpful.

 

EXPERIENCE: Minimum 1-2 years’ experience in a medical office environment. Experience with Windows applications, proficient use of computer, Microsoft Word and Microsoft Excel. Strong communication, verbal and written and interpersonal skills. Ability to analyze and solve problems with limited assistance. Ability to maintain confidentiality.


LANGUAGE SKILLS:   Knowledge and use of the English language, Bi-lingual a Plus

 

MATHEMATICAL SKILLS:   Basic math skills

 

REASONING ABILITY:   Critical thinking, analytical and problem-solving skills.

 

LICENSURE / CERTIFICATION:   CCA certification, CPC certification

 

STANDARD REQUIREMENTS

 

  •  Supports an ethical standard which complies with a code of conduct free of conflicts of interest.
  • Supports the Mission and Values of Optimus Health Care, Inc.
  • Supports, cooperates with, and implements specific procedures and programs for:

~Safety, including universal precautions and safe work practices, established fire/safety/disaster plans, risk management, and security, report and/or correct unsafe working conditions, equipment repair and maintenance needs. ~Confidentiality of all data, including patient, employee and operations data.

~Quality Assurance and compliance with all regulatory requirements.

~Compliance with current law and policy to provide a work environment free from sexual harassment and all illegal and discriminatory behavior.

  •  Supports and participates in common teamwork:
  • Cooperates and works together with all co-workers; plan and complete job duties with minimal supervisory direction, including appropriate judgment.
  • Uses tactful, appropriate communications in sensitive and emotional situations.
  • Follows up as appropriate with supervisor and co-workers regarding reported complaints, problems and concerns.
  • Promotes positive public relations with patients, family members and guests. 

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