Medical Billing Specialist

3 weeks ago

Sheboygan, Wisconsin, United States Sheboygan County, WI Full time

We are seeking a skilled Medical Billing Specialist to join our team at Sheboygan County, WI. As a key member of our finance department, you will be responsible for managing patient accounts and insurance collections. Your expertise in medical billing and coding will play a crucial role in ensuring accurate and timely reimbursement for our services.



About the Role

This is a dynamic opportunity for a motivated and detail-oriented individual to take on a challenging role in medical billing. As a Medical Billing Specialist, you will be responsible for gathering patient information, verifying insurance coverage, and submitting claims to Medicare Part A, Part B, Medical Assistance, and private payors. You will also be required to maintain accurate records of all submitted claims, authorizations, and communications with insurance companies.



Key Responsibilities


  • Gather Patient Information: name, date of birth, address, and insurance information
  • Verify Insurance Coverage. Contact the insurance provider to confirm coverage details for Medicare Part A, Part B, Medical Assistance, and private pay
  • Ensure that the services provided are covered under the patient's policy
  • Complete the necessary claim forms for each type of billing:
  • Medicare Part A: Use CMS-1450 (UB-04) for facility claims
  • Medicare Part B: Use CMS-1500 for professional services
  • Medical Assistance: Refer to state-specific guidelines and forms
  • Private Pay/Insurance Claims: Customize forms as per the insurance provider's requirements
  • Include relevant codes (CPT, HCPCS, ICD-10) for the services rendered
  • Initiate prior authorization requests with the insurance companies
  • Provide all necessary documentation to support the authorization request
  • Keep track of the authorization status and follow up as needed
  • Ensure all claims are submitted electronically when possible for faster processing
  • Monitor the status of submitted claims regularly
  • Use software or tracking systems to keep tabs on pending, denied, or paid claims
  • Review denied claims to identify the reason for denial
  • Gather additional information or documentation to resolve the issues
  • Resubmit claims or appeal decisions as necessary
  • Maintain accurate records of all submitted claims, authorizations, and communications with insurance companies
  • Ensure compliance with HIPAA and other regulations regarding patient information
  • Keep track of deadlines for submitting claims to ensure they are submitted within the required time frames to avoid delays in payment


Requirements

To be successful in this role, you will need:




  • Associate degree, technical school degree, or equivalent in accounting or business-related coursework
  • Alternatively, 5 years of extensive medical billing experience
  • Preferred: 2 years of experience in medical billing with knowledge of Medicare, Medicaid, and third-party payors
  • Experience with Point Click Care is desirable
  • Proficient in MS Office applications (Word, Excel, etc.)
  • Excellent oral and written communication abilities
  • Ability to establish and maintain effective relationships with the public, staff, and inter-departmental teams
  • Ability to maintain a high level of confidentiality and discretion
  • Experience dealing with sensitive data in a confidential manner
  • Knowledge of and compliance with federal, state, county, and facility regulations
  • Demonstrates reliability, resourcefulness, and good judgment
  • Ability to follow complex oral and written instructions
  • Exhibits tact and courtesy in all interactions


Salary and Benefits

The salary for this role is estimated to be around $50,000 - $60,000 per year, depending on experience. We also offer a comprehensive benefits package, including health insurance, retirement plan, and paid time off. Additionally, we provide opportunities for professional growth and development.



Why Join Our Team?

At Sheboygan County, WI, we value our employees and offer a dynamic work environment. Our team is committed to providing high-quality services to our residents, and we are looking for individuals who share our passion for delivering exceptional care. If you are a motivated and detail-oriented individual who is looking for a challenging role in medical billing, we encourage you to apply.

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