Medical Billing and Collections Specialist
4 weeks ago
Job Summary
The Medical Billing and Collections Specialist's purpose is to process medical billing claims, collect patient or provider payments, resolve questions and problems with a customer's accounts, process patient refunds, appeals to include re-determinations and resubmissions of billing to patient payers for payment on medical supply orders.
Key Responsibilities:
- Generate timely billing of assigned payers.
- Ensure claims are received and processed by payers.
- Review A/R balances to ensure timely and accurate payments are received.
- Maintain current and accurate computer data, including documentation of all account activity performed in A/R systems.
- Bill all co-insurance accounts per payer-specific guidelines.
- Complete cash logs as required.
- Review and understand correspondence received from third-party payers, including remittance advices, Explanation of Benefits, denial letters, etc.
- Receive payment denials and investigate the reason and rectify the situation with the payer or patient.
- Receive inbound and place outbound calls from and to customers, Medicare, Medicaid, and Commercial insurance providers regarding patient accounts.
- Provide written correspondence to audit requests, including investigation and obtaining of appropriate documentation to be attached to response.
- Document the status of billing and payment process in patient accounts for future follow-up and keep current on payer requirements via research and coaching to ensure guidelines and procedures are being met for each payer.
- Answer and follow up on calls from patients with billing questions, complete all end-of-month reports as requested, directed, or assigned, and complete all internal system service ticket requests as assigned.
- Work miscellaneous projects and tasks on an as-needed basis.
Requirements:
- Education and Work Experience:
- Minimum of five (5) years of medical insurance/healthcare billing and collections experience with a deep understanding of medical billing rules and regulations.
- Thorough understanding of medical billing, collections, and payment posting, revenue cycle, third-party payers, Medicare; Medicare Advantage, strong knowledge of state and Federal payer regulations.
- Minimum five years of direct supervision of 12 or more staff.
- Well-versed in CPT and ICD10 codes and procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits, and appeal processes.
- Strong leadership, team development, and business skills.
- Solid understanding of billing software and electronic medical records (EMR) eCW experience preferred.
- Certificates and Licenses:
- Valid Driver License.
- Certified Coder a plus.
- Skills:
- Computer Literacy.
- Customer Service and Relations.
- Diplomacy.
- Math Aptitude.
- Oral Communication.
- Organizational Management.
- Planning.
- Time Management.
- Written Communication.
Benefits:
- Comprehensive benefits package, including Health, Vision, Dental, and Life insurances.
- PTO Accrual and Holidays.
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