Medical Billing Operations Specialist

3 weeks ago


Sharon, Pennsylvania, United States The Primary Health Network Full time
About the Role

We are seeking a highly skilled and experienced Medical Billing Operations Specialist to join our team at The Primary Health Network. In this critical role, you will be responsible for overseeing the day-to-day operations of our ancillary billing department, ensuring compliance with federal, state, and payer regulations, and fostering strong relationships with insurance companies.

Estimated Salary: $60,000 - $80,000 per year, depending on experience.

Job Description

This position requires a bachelor's degree in a business administration or related field, preferably with 5 years of medical office experience in contracting, billing, A/R, credentialing, or collections. Strong attention to detail, problem-solving skills, and excellent computer skills are essential.

Responsibilities:

  • Review all insurance contracts and requests necessary changes
  • Review remittance advice for payment accuracy and or contractual adjustments to ensure reimbursement is paid based on contract rates
  • Research reimbursement patterns for areas/locations of our sites compared to our rates
  • Performs annual impact analysis of Medicare and Medicaid annual rate changes
  • Performs annual impact analysis of fee schedule changes
  • Researches new procedure codes and reviews reimbursement rates with insurance companies
  • Reviews insurance updates, stays apprised of changes, and attends meetings with insurance carriers and representatives
  • Works with other departments and/or contractors as needed to optimize reimbursement i.e.: CHIP and WRAP
  • Builds strong working relationships with provider relations representatives at the insurance companies
  • Maintains confidentiality and integrity of data contained in provider contract and credentialing files as well as patient, employee, and organizational information.
  • Ensures the activities of the ancillary billing operations within the Network are conducted in a manner that is consistent with overall department protocol, and are following federal, state, and payer regulations, guidelines and requirements.
  • Assists in the development and implementation of policies and procedures, in accordance with federal and state regulations and company mission.
  • Oversees the supervision of ancillary personnel, which includes time card approval and changes, work allocation and production, training and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peek productivity and performance.
  • Assist with month-end close duties of billing system.
  • Assist Finance Department with duties as assigned.
  • Performs other department related duties as assigned.


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