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Medical Billing Specialist
2 months ago
- High School Diploma or Equivalent required
- Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
- Proficient in Microsoft Word, Outlook, Excel, and 10 key calculators
- Basic knowledge of medical terminology, including CPT/ICD-10 coding
- Effective communication abilities for phone contacts with insurance payers to resolve issues
- Knowledge of medical terminology likely to be encountered in medical claims
- Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Planning and organizing
- Attention to detail, accuracy, and efficiency
- Problem-solving
- Teamwork
- Multitasking
- Customer service
- Electronic Medical Records (EMR)
- Communication skills - verbal and written
- Integrity
- Prolonged periods sitting at a desk and working on a computer
- Must be able to lift up to 15 pounds at times
- The Billing Specialist is responsible for posting insurance payments, entering charges, and assisting patients with their accounts
- Position requires accuracy, thoroughness, and a good understanding of insurance procedures for referrals, co-pays, deductibles, allowable, CPT codes and Dx codes
- Work with personal information and maintain patient confidentiality
- Weekly and monthly reporting to executive director and billing supervisor
- Verify the accuracy of all claims before submission and ensure all claims are submitted with a goal of zero errors and review claims and claims denials to ensure maximum reimbursement for services provided
- Utilize monthly aging accounts receivable reports for follow-up on unpaid claims aged over 30 days
- Review referrals and authorizations
- Respond to questions and complaints from patients or insurance companies
- Research and appeal denied claims
- Read and interpret insurance explanation of benefits and respond to inquiries from insurance companies, patients, and providers
- Other responsibilities as judgment or necessity dictate
- Become OCSR (Ophthalmic Coding Specialist- Retina) certified in the first 6 months of employment. All associated costs covered.
- Meet defined department goals and activity metrics
- Initiate late payment notices to relevant parties
- Identify and bill secondary and/or third-party insurances
- Follow set billing processes and procedures and follow all regulations and guidelines set by Medicare, state programs, and HMO/PPO
- Ensure patient information is accurate and complete and request any missing patient information
- Create both paper and electronic copies of documentation
- Collect delinquent accounts by establishing payment arrangements with patients; monitoring payments; following up with patients when payment lapses occur
