Medical Billing and Coding Specialist

2 weeks ago

Tomball, United States Pulse Physician Organization Full time

**JOB SUMMARY**:
The medical billing and collection specialist is responsible for ensuring accurate billing, timely

submission of electronic and/or paper claims, monitoring claim status, researching rejections and

denials, documenting related account activities, posting adjustments and collections of Medicare,

Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and

collection specialist must possess critical thinking skills and understanding of Medicare, Medicaid

eligibility requirements as well as commercial insurance payer payment methods to correctly

record contractual adjustments base on payer contracts or government regulations. In addition, the

medical billing and collection specialist must demonstrate proficiency with billing system to

ensure all functionality is utilized for the utmost efficient processing of claims.

**MAJOR DUTIES & RESPONSIBILITIES**:

- Responsible for charge and payment entry within Electronic Health Record. Coordinates and

clarifies with providers, when necessary, on information that seems incomplete or is lacking

for proper account/ claim adjudication;
- Responsible for correcting, completing, and processing claims for all payer codes;
- Analyze and interpret that claims are accurately sent to insurance companies;
- Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports;
- Process appeals online or via paper submission;
- Assist in reconciling deposit and patient collections;
- Assist with billing audit related information;
- Attend provider meetings/ workshops when needed; 2
- Communicate with billing and credentialing coordinator to identify and resolve audit review issues;
- Process billing calls and questions from patients and third party carriers;
- Answer/respond to correspondence related to patient accounts. Is available to answer billing and changes related inquiries by patients, staffs, Managed Care Organization, etc.;
- Communicate daily with internal and external customers via phone calls and written communications;
- Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Revenue Cycle Director. Research, record findings, and communicates effectively with Manager to achieve optimum performance;
- Pursue and participate in education to remain current with changes in the Healthcare industry;
- Maintain patient confidence and protects medical office operations by keeping patient information confidential;
- Contribute to team effort by accomplishing related results as needed;
- Promote effective working relations and work effectively as part of a team to facilitate the department’s ability to meet its goals and objectives;
- Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to insure a professional, responsible and courteous environment;
- Attend on-site/off-site community engagement activities and on-site/off-site clinic events as needed;
- Perform other duties as assigned to support HOPE Clinic’s Mission, Vision, and Values.

**QUALIFICATION REQUIREMENTS**:

- Minimum of two years of related experience in a business, medical or technical environment;
- Previous experience in a medical office setting and/or experience with an Electronic Medical Record a plus, eClinical Works experience preferred;
- Customer service driven;
- Understanding of medical terminology and insurance laws/guidelines;
- Excellent organization and time management skills along with excellent oral and written communication skills;
- Strong team player;
- Ability to learn quickly, build and maintain long term relationships and work with mínimal

supervision;
- Strong written and verbal communication skills; strong analytical, organizational and time

management skills required.

**EDUCATION and/or EXPERIENCE**: High School Diploma equivalent required, Associate Degree preferred. Certified Biller and Coder strongly preferred.

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Monday to Friday

**Experience**:

- ICD-10: 3 years (required)
- Medical billing and collection: 3 years (required)

Ability to Relocate:

- Tomball, TX: Relocate before starting work (required)

Work Location: In person

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