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Medical Billing Specialist
2 months ago
The Medical Billing AR & Denial Follow-up Specialist plays a critical role in ensuring timely reimbursement for Behavioral Health and Substance Use Disorder programs at BHN.
Key Responsibilities:- Follow up on all assigned claims to ensure timely reimbursement and bring claims to closure.
- Review denied claims for accuracy to ensure coding, billing rates, and modifiers are accurate before sending appeals or reconsiderations to payers.
- Investigate claims with no payer response to ensure the payer received the claim.
- Navigate payer websites and appeal processes as defined by all payers, including commercial and government payers.
- Review and find trends or patterns of denials to prevent errors.
- Assist and confer with the EHR Matrix team and Billing Manager concerning any coding or modifier setup issues.
- Identify missing payments, overpayments, and analyze credits on accounts.
- Initiate refund requests for credit and overpayments.
- Deliver timely required reports to the management team and initiate and communicate the resolution of issues.
- Support and participate in process and quality improvement initiatives.
- Provide exceptional customer service, answering individual served and insurance calls, and promptly responding to requests for information.
- High School Diploma or GED required.
- Minimum of 5 years of experience in a medical billing department with strong AR account follow-up, appeals, and Behavioral Health codes and modifier knowledge required.
- Demonstrated knowledge of and experience in healthcare medical billing, claims processing, follow-up, and appeals required.
- CPC certification is preferred but not required.
- Current knowledge of HIPAA compliance, 42 CFR requirements, and changing regulatory guidelines.
