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Healthcare Billing Specialist
2 months ago
Position Overview: The Healthcare Billing Specialist is an essential contributor to the financial operations of medical facilities, ensuring the fiscal stability of healthcare services. This role encompasses a wide array of tasks aimed at securing accurate and prompt reimbursement for healthcare services rendered. The Healthcare Billing Specialist is responsible for navigating the complexities of the billing cycle, which includes thorough examination of medical records, as well as communication with insurance providers and patients.
Key Responsibilities:
- Manage billing processes by generating and submitting claims to a variety of insurance companies and payers. This task requires meticulous attention to detail to confirm the accuracy and completeness of patient data, diagnoses, and procedures, ensuring compliance with coding standards such as ICD-10 and CPT.
- Conduct insurance verification to confirm patient coverage, obtain necessary authorizations, and ensure adherence to insurance protocols, thereby facilitating a smooth billing process.
- Proactively follow up on pending claims, addressing any denials by engaging in effective communication with insurance providers to resolve issues and secure timely payments. This necessitates a strategic approach to achieve favorable financial results for the healthcare institution.
- Engage with patients to clarify billing inquiries, assist with financial questions, and set up payment plans. A successful Healthcare Billing Specialist not only excels in the technical aspects of billing but also possesses strong interpersonal skills to communicate effectively with patients.
- Stay informed about healthcare regulations and insurance policies to ensure compliance with industry standards and legal obligations. The Healthcare Billing Specialist is expected to maintain organized billing records, produce insightful financial reports, and collaborate with other healthcare professionals to enhance the billing process.
- Perform additional duties as required.
- 2-5+ years of experience in outpatient billing and collections.
- Familiarity with NCCI editing.
- Understanding of Commercial and Government payer guidelines, including Worker's Compensation.
- Proficient in medical terminology, HIPAA regulations, and other essential governmental standards.
- Highly organized, detail-oriented, and capable of meeting deadlines.
- Able to interpret various insurance documents, analyze accounts, and follow detailed procedures efficiently.
- Strong computer skills, including proficiency in Word, Excel, and billing software.
- Visual acuity to inspect and analyze work closely, along with the ability to hear sounds with or without correction.
- Ability to perform physical activities such as climbing, stooping, kneeling, reaching, standing, walking, pulling, pushing, and lifting up to 40 pounds occasionally and/or up to 10 pounds constantly.
- Moderate physical activity related to primarily administrative tasks.
- Capability to ascend or descend stairs and ramps using legs and arms.
- Frequent use of wrists, hands, and fingers in repetitive motions.
- While performing job duties, the employee is often required to stand, walk, sit, reach with hands and arms, and communicate verbally.
- Occasional requirements include stooping, kneeling, crouching, or crawling.
- Close visual acuity is necessary for tasks such as preparing and analyzing data, transcribing, and viewing computer screens.
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