Medical Office Billing Specialist

4 weeks ago


Rockford, Illinois, United States Mercy Health Full time

Job Summary:

We are seeking a highly skilled Medical Office Billing Specialist to join our team at Mercy Health. As a key member of our Revenue Cycle department, you will be responsible for ensuring claims are resolved with third-party payers in a timely manner.

Key Responsibilities:

  • Resolve claims that fail payer rejection edits to correct errors and submit corrected claims.
  • Assess errors, locate information to correct them, and follow up on claims for resolution.
  • Work with other areas in the Revenue Cycle to obtain necessary information to correct errors or supply additional information for claim adjudication.
  • Remain up-to-date on regulatory requirements through informal and formal updates, including self-study of payer bulletins and guidelines.
  • Verify claims are received by the payer and follow up to obtain payment via phone calls, portal, or website use.
  • Review claim adjustment reason codes or explanations of benefits received by the payer to determine reasons for denials and follow up accordingly.
  • Evaluate next steps and take action to call the payer, resubmit, dispute, appeal, or reconsider as required by the payer.
  • Obtain and send medical records during the appeals process when needed to substantiate medical necessity.

Requirements:

  • Ability to review billing forms for accuracy.
  • Excellent communication and problem-solving skills.
  • Ability to work in multiple software applications simultaneously.
  • Basic understanding of Microsoft Excel.
  • Healthcare billing experience preferred.

What We Offer:

  • A dynamic and supportive work environment.
  • Opportunities for professional growth and development.
  • A comprehensive benefits package.


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