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Billing Specialist
2 months ago
PURPOSE OF POSITION:
The primary purpose of this position is to prepare medical claims for timely submission to payers.
ESSENTIAL FUNCTIONS:
Primary accountability and results for specific functions. The list of essential functions is not exhaustive and may be supplemented or changed, as necessary.
1.
Review provider claims to ensure accurate representation of services rendered;
2.
Prepare claims for reimbursement to all applicable entities;
3.
Assess claims to ensure adherence with payer guidelines;
4.
Maintain an understanding of medical insurance programs and coverage offered under various plans;
5.
Research and work collaboratively with clinic staff to capture all billing activities (e-bill management). This may require access to additional information systems (EMR or Data Warehouse)
6.
Contact patients and/or provider offices directly to secure current and accurate insurance information and provide guidance to patients on policy terms;
7.
Respond to RCM team and vendors promptly to address information needed for claim resubmission and denial resolution;
8.
Assist in the development of protocols and workflows to ensure correct billing and maximum reimbursement;
9.
Understanding of payer websites and content for eligibility purposes. Understanding navigation of Practice Management integrated eligibility module;
10.
Deliver exemplary customer service to provide a positive experience across the organization;
11.
Perform other duties assigned by management.
ADDITIONAL RESPONSIBILITIES:
*
Assist with implementing updated guidelines
*
Remain current with respect to regulatory changes
*
*
*
POSITION QUALIFICATIONS:
To perform at a proficient level and be fully qualified, a person would be expected to have:
1.
Education (Minimum Needed): High School Diploma or GED required, Certificate from college or technical school preferred
2.
Experience (Minimum Needed): 1+ years’ experience in billing or medical office operation or billing required
3.
Specialized Knowledge Needed for Performance of Job: Basic knowledge of ICD-10 and CPT Codes required, Understanding of Revenue Cycle Management preferred
4.
Special Skills: Ability to multi-task with accuracy required, strong organizational skills
5.
Other: Strong customer service and communication skills with ability to utilize computer programs
