Medical Billing Specialist

4 weeks ago

Moore, United States Private Clinical Practice Full time
Job DescriptionJob Description

Synopsis of Responsibility:

The Billing Specialist coordinates the day-to-day billing operations to maximize revenue cycle management processes. enhance patient, physician, and customer relations with account managers. The position requires strong dedication, comprehensive decisions-making, proficient business acumen, project management, critical thinking, analytical skills, capable judgement, strong time management. Team player is a must.

 

Job Summary:

  • Billing Process Knowledge: Thorough understanding of professional provider billing, inclining office visits, DME, X-rays, labs, in-office procedures, and surgeries.
  • Insurance Knowledge: Understand deductibles, co-insurance, co-pays, and EOBs. Handle claims submission, follow-ups, reconsiderations, appeals, and denial/rejections management.
  • Claims Management: Resolve unpaid insurance claims within 45 days. Process and post payments from insurance and patients. Generate and send monthly patient statements.
  • Pre-Surgery Coordination: Ensure deductibles, co-insurance, insurance authorizations/approvals for surgeries and procedures.
  • Work Comp and MVA: Knowledge of these areas is a plus. Requires specialty knowledge.

 

Job Specific Requirements:

  • Claims Management:
    • Manage billing and claims for accuracy in accordance with insurance payers and regulations.
    • Daily claims submissions.
    • Analyze and manage reporting to identify trends affecting charges, denials, and collections.
    • Monitors reimbursement from managed care networks and insurance carriers.
    • Maintain up to date information regarding coding, insurance carriers monitoring insurance payer websites consistently.
    • Conduct billing operations consistent with department and organizational protocol. Create standard operating processes when applicable.
    • Meet leadership monthly reporting of wellbeing of accounts receivables to discuss collections and develop strategies to reduce denials.
    • Advice Senior Management on operational account receivables concerns or upcoming changes regarding Insurance payers
    • Serve as a strong resource for revenue cycle workflow and software applications that would enhance department processes.
    • Coordinate billing operations, including claims submissions, payments postings, accounts receivables follow-up, and reimbursement management.
    • Process and complete appeals.
    • Share updates from governmental payers with appropriate personnel.
    • Follow up on delinquent account and resolve outstanding balances with patients and insurance payers.
    • Collaborate with other patient access staff as to assist with archiving RCV goals.
    • Post recoups daily and review contractual adjustments as necessary.
    • Reconcile payer remittances after electronic posting.
    • Submit encounters/batches before the close of business.
    • Complete required reports daily and as needed.
    • Maintain aging under 45 days.
    • Facilitate Medical Records from insurance payers within 48 hours.
    • Enter accurate and thorough comments on patient accounts/EMR for potential audit and correspondence with need to know staff.

 

  • Reporting, Analytics, & Benchmarking
    • Create monthly, quarterly, and yearly comprehensive reporting with a KPI dashboard to demonstrate key performance initiatives related to revenue cycle management for transparency.

 

Education and Experiences:

  • Education: High school diploma or GED.
  • Experience: Minimum one-year experience in collections and medical billing. Strong time management, multi-tasking, organization, scheduling, and customer services skills requited.
  • Billing Certification (i.e. CPC Certification, CBCS, etc.) referred but not required.

 

Physical Requirements:

  • Fluency in English
  • Ability to lift 20-30 pounds
Company DescriptionPrivate Clinical Practice. Innovative, disciplined, and strong work ethic

Team oriented, always striving for the stars. Optimal performer. Patient care and service is coreCompany DescriptionPrivate Clinical Practice. Innovative, disciplined, and strong work ethic\r
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Team oriented, always striving for the stars. Optimal performer. Patient care and service is core

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