Procedural Billing Specialist

2 weeks ago

New York, United States Mount Sinai Health System Full time

The Procedural Billing Specialist I is responsible for multiple components of the complex billing and coding process for specialized procedures, including Accounts Receivable, Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures. S/he coordinates activities related to data entry of billing, and demonstrates proficiency in analysis and problem resolution to ensure accurate and timely payment of claims and collection. The Specialist works directly with the Department Administrator. Reports to Billing Manager/Revenue Cycle Manager.

**Responsibilities**

1. Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.

2. Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances.

3. Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations.

4. Develop and manages fee schedules and for self-pay patients.

5. Processes Workers Compensation claims and addresses/resolves all discrepancies.

6. Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.

7. Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.

8. Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.

9. Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis.

10. Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.

11. Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.

12. Researches unidentified or misdirected payments.

13. Works credit balance report to ensure adherence to government regulations/guidelines.

14. Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.

15. Identifies and resolves credentialing issues for department physicians.

17. Meets with practice management, leadership and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.

18. Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.

19. Other identified duties as assigned.

**Qualifications**
- Associates Degree preferred
- 5 years experience in medical billing or health claims, with experience in IDX billing systems in a health care or insurance environment, and strong familiarity with ICD/CPT coding
- Licensing: None but CPC strongly preferreding (e.g., CPC) is preferred but not required.

Pay: $58,661.00 - $81,675.00 per year

**Benefits**:

- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

Work setting:

- Hospital
- Office

**Education**:

- Associate (preferred)

**Experience**:

- Medical billing: 5 years (required)

Work Location: In person

  • Billing Specialist

    4 weeks ago

    New York, United States Skill Bird LLC Full time

    **Job Title: Senior Billing Specialist** **Location: NYC** **Job Overview**: The Senior Billing Specialist assists attorneys with the preparation of bills for clients, ensuring that the client bills are processed timely and in accordance with the client agreement. The Senior Billing Specialist answers billing questions and researches billing related...

  • Billing Specialist

    4 days ago

    New York, United States Lewis Brisbois Bisgaard & Smith LLP Full time

    **Overview**: - The New York office is seeking a Billing Specialist with legal experience. The Billing Specialist will have excellent communication skills and a high level of professional service to clients, management, attorneys and other staff in order to effectively, efficiently and successfully administer monthly billing, and research, respond to and...

  • Billing Specialist

    3 weeks ago

    New York, United States The Forum Group Full time

    Exciting Job Opportunity for a Legal Billing Specialist! Join a leading international law firm at the forefront of legal innovation, serving top financial institutions and Fortune Global 500 companies worldwide. As a globally recognized firm, they value dynamic individuals committed to service, innovation, and professional growth.Candidates must be...

  • Billing Specialist

    3 weeks ago

    New York, United States The Forum Group Full time

    Exciting Job Opportunity for a Legal Billing Specialist! Join a leading international law firm at the forefront of legal innovation, serving top financial institutions and Fortune Global 500 companies worldwide. As a globally recognized firm, they value dynamic individuals committed to service, innovation, and professional growth.Candidates must be...

  • Billing Specialist

    4 weeks ago

    New York, United States The Forum Group Full time

    Exciting Job Opportunity for a Legal Billing Specialist! Join a leading international law firm at the forefront of legal innovation, serving top financial institutions and Fortune Global 500 companies worldwide. As a globally recognized firm, they value dynamic individuals committed to service, innovation, and professional growth.Candidates must be...

  • Billing Specialist

    5 days ago

    New York, United States The Phoenix Group Full time

    We are seeking an experienced Legal Billing Specialist to join our prestigious law firm in New York City. In this role, you will play a crucial part in our finance team, handling all aspects of legal billing and ensuring accuracy and compliance with billing policies. The ideal candidate is proficient in Elite Aderant eBilling Hub or Elite 3E and has a strong...

  • Billing Specialist

    15 hours ago

    New York, United States The Phoenix Group Full time

    We are seeking an experienced Legal Billing Specialist to join our prestigious law firm in New York City. In this role, you will play a crucial part in our finance team, handling all aspects of legal billing and ensuring accuracy and compliance with billing policies. The ideal candidate is proficient in Elite Aderant eBilling Hub or Elite 3E and has a strong...

  • Billing Specialist

    5 days ago

    New York, United States The Phoenix Group Full time

    We are seeking an experienced Legal Billing Specialist to join our prestigious law firm in New York City. In this role, you will play a crucial part in our finance team, handling all aspects of legal billing and ensuring accuracy and compliance with billing policies. The ideal candidate is proficient in Elite Aderant eBilling Hub or Elite 3E and has a strong...

  • Billing Specialist

    2 days ago

    New York County, New York, United States Lewis Brisbois Full time

    Overview: The New York office is seeking a Billing Specialist with legal experience. The Billing Specialist will have excellent communication skills and a high level of professional service to clients, management, attorneys and other staff in order to effectively, efficiently and successfully administer monthly billing, and research, respond to and resolve...

  • Billing Specialist

    7 days ago

    New York, United States Incubation Systems Private Limited Full time

    Job Overview:We are seeking a detail-oriented Sales Billing Specialist to join our team. The ideal candidate will have experience in sales billing and coding.• At least three (3) years’ experience in processing invoices• A strong understanding of the billing process (e.g. ensure invoices match the contract, add purchase orders (if necessary), raise...

  • Senior Billing Specialist

    4 weeks ago

    New York, United States AMS Staffing, Inc. Full time

    Job DescriptionJob DescriptionPlease send resume in WORD format should you be interested in the following Senior Billing Specialist position located in New York City. This is a full-time, permanent position with a salary between 100-120K plus awesome benefits. If youre not interested, please pass along to your colleagues as we do pay referral fees.Job Title:...

  • Billing Specialist

    5 days ago

    New York, United States The Bridge Inc. Full time

    The Bridge’s mission is to change lives, by offering help, hope, and opportunity to the most vulnerable in our community. We offer a comprehensive range of evidence-based rehabilitative services, including mental health and substance abuse treatment, housing, vocational training and job placement, healthcare, education, and creative arts therapies. The...

  • Medical Billing Specialist

    2 weeks ago

    New York, United States Good Health Psychiatric Services P.C.Rudoy Medical P.C. Full time

    Job DescriptionJob DescriptionSalary: $20-25 per hourPosition Available: Medical Billing Specialist for Mental Health PracticeLocation: Downtown Brooklyn, New YorkCompany Overview: We are an established psychiatric practice located in New York dedicated to providing top-quality mental health services to our community. Currently, we are seeking a skilled and...

  • Billing Specialist

    7 days ago

    New York, United States The Bridge Inc. Full time

    The Billing Specialist will be responsible for Billing and the follow-up of unpaid or rejected insurance claims for assigned carriers and will work with insurance companies, Billing, and/or Program staff to resolve account issues. **Responsibilities and Duties** - Strong working knowledge of Article 32 and Article 31 claims processing. - 2+ years of...

  • Billing Specialist

    4 weeks ago

    New York, United States PBS Facility Services Full time

    Job DescriptionJob DescriptionJob Title: Billing Specialist   About the role:   PBS Facility Services is seeking a detail-oriented and organized Billing Specialist to join our dynamic team. As a Billing Specialist, you will play a crucial role in accurately and efficiently managing the billing process. Your primary responsibility will be to ensure...

  • Dental Billing

    2 weeks ago

    New York, United States Diamond Braces Full time

    Description: Diamond Braces is hiring experience dental billing and coding specialists to join our financial team. We provide excellent employee packages and work hard to provide a world-class work experience. This is a remote, work-from-home opportunity. What you can expect with a career at Diamond Braces: * Ample growth & advancement opportunities *...

  • Billing/Precertification Specialist

    1 week ago

    New York, United States Kwfc Radio Full time

    Description: Gastroenterology Consultants of Augusta is looking for an experienced Billing/Precertification Specialist to join our billing team. Duties include insurance verification, prior authorization, accounts receivable and phone customer service. The position is full time, Monday thru Friday, 8 am to 4:30 pm. Qualifications: A high school diploma or...

  • Billing Specialist

    6 days ago

    New Gloucester, United States MOUNTAIN LTD Full time

    Mountain Ltd. has an opening for a Billing Specialist to join our team! The Billing Specialist is a pivotal role supporting billing through client-specific systems and processes. As the Billing Specialist, the primary focus is identifying billing priorities and accurately inp...

  • Senior Billing Specialist

    4 weeks ago

    New York, United States AMS Staffing, Inc. Full time

    Job DescriptionJob DescriptionLEGAL BILLING (Aderant or Elite/3E) EXPERIENCE REQUIRED!The position will allow for a hybrid work schedule with 15/ 16 days WFH!!!Please send your resume in WORD format should you be interested in the followingSr. Client Billing Specialist position. Our client is based out of the New York, NY area. This is a full-time role with...

  • Senior Billing Specialist

    4 weeks ago

    New York, United States AMS Staffing, Inc. Full time

    Job DescriptionJob DescriptionLEGAL BILLING (Aderant or Elite/3E) EXPERIENCE REQUIRED!The position will allow for a hybrid work schedule with 15/ 16 days WFH!!!Please send your resume in WORD format should you be interested in the followingSr. Client Billing Specialist position. Our client is based out of the New York, NY area. This is a full-time role with...