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Medical Billing Specialist

3 months ago

Tomah, United States Tomah Health Full time

POSITION DETAILS

Full-time with benefits; Monday through Friday, 8am to 4:30pm; 80 hours in the two week pay period. Pay is based on experience.

JOB SUMMARY

The Medical Billing Specialist is responsible for responding to and resolving a variety of account, billing and payment issues from insurance, patients, and customers using an automated system. Reviews the medical record and abstracted information as necessary to provide insurance claim information or to resolve incoming correspondence regarding patient services received. Reviews accounts to determine correct adjustments have been applied, payments posted, and refunds distributed. Uses excellent customer service and interpersonal skills when interacting with insurance, patients, and customers, following confidentiality guidelines. Makes appropriate decisions that require individual and/or team analysis - utilizing good problem solving skills. Interprets, applies and communicates federal and hospital-wide policies regarding the medical and financial aspects of patient care to ensure optimal third party payment for the patient and the hospital. Follows hospital compliance plan.

MAJOR JOB FUNCTION
- Process all claims, including secondary insurances, in a timely and efficient manner, performing all associated duties in order to ensure completeness and correctness of all claims information, facilitating maximum reimbursement.
- Resolve account credits/refunds within 30 days of credit.
- Follows up on account discrepancies and denials within 45 days of receipt.
- Handles phone, mail and personal inquiries from and regarding patient’s accounts in a professional and timely manner.
- Participates in educational opportunities offered by hospital for job and personal development.
- Takes an active role in facilitating team approach to functions within the department.
- Responsible for being familiar with regulatory changes issued by intermediaries and insurance companies and communicate changes to the manager.
- Ensures that the hospital’s policy on confidentiality is strictly followed.
- Performs other duties as assigned.

EDUCATIONAL REQUIREMENTS
- High School diploma or equivalent required.
- Three years experience in specialized billing and knowledge of medical terminology preferred.

QUALIFICATIONS/SKILLS
- Mathematical ability required for reviewing statistical data on various financial records.
- Knowledge of electronic billing systems preferred.
- Knowledge of insurance plans preferred.
- Excellent verbal and written communication skills.
- Excellent human relation skills as demonstrated by the ability to interface positively with all customers and employees.
- Must have the ability to work with frequent interruptions, under stress and with mínimal supervision.
- Needs to possess a high level of intelligence, integrity, sense of responsibility and ability to comprehend and analyze details.

JOB REQUIREMENTS
- Frequently required to stand, walk and reach with hands and arms and is also required to sit, climb or balance, stoop, kneel and crouch.
- Must occasionally lift and/or move up to 15 pounds.

Location: Tomah Health - Patient Financial Services

Schedule: Full Time, Day Shift, 8am to 4:30pm