Medical Billing Specialist

4 weeks ago

Arkansas, United States Pafford Medical Services Full time
Job Summary:

As a Medical Billing Specialist at Pafford Medical Services, you will play a vital role in ensuring the accuracy and efficiency of our billing processes. Your primary responsibility will be to obtain referrals and pre/post-authorizations for ambulance services, as well as check eligibility and benefits verification. You will also review insurance and facility claims for accuracy and completeness, prepare and transmit claims using billing software, clearinghouse, and payer websites, and follow up on unpaid claims within the standard billing cycle timeframe. Additionally, you will review underpaid claims for appropriate escalation steps to ensure appropriate reimbursement for services, call insurance companies regarding any payment discrepancies, identify and bill secondary or tertiary insurance, process incoming mail, and take appropriate follow-up actions to resolve accounts. You will also research and appeal denied claims, answer patient or insurance telephone inquiries, contact patients to escalate issues with insurance companies, and maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Key Responsibilities:

Obtain referrals and pre/post-authorizations for ambulance services
Check eligibility and benefits verification
Review insurance and facility claims for accuracy and completeness
Prepare, review, and transmit claims using billing software, clearinghouse, and payer websites
Follow up on unpaid claims within standard billing cycle timeframe
Review underpaid claims for appropriate escalation steps to ensure appropriate reimbursement for services
Call insurance companies regarding any payment discrepancies
Identify and bill secondary or tertiary insurance
Process incoming mail and take appropriate follow-up actions to resolve accounts
Research and appeal denied claims
Answer patient or insurance telephone inquiries
Contact patients to escalate issues with insurance companies
Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Requirements:

High School Diploma or GED
Minimum of one year revenue cycle management experience or related experience
Proficient with a PC
Knowledge of Health Insurance Portability and Accountability Act (HIPAA)
Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes)
Knowledge of medical terminology
Knowledge of Medical Billing
Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and commercial payers
Customer service skills for interacting with patients regarding medical claims and payments
Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections
Ability to work independently and with a group
Working knowledge of MS Word, Excel
Ability to maintain effective working relationships
Thorough knowledge of office practices
Ability to type at least 35 words per minute
Proficiency using 10 key
Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards
Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards
The employee may occasionally be required to lift and/or move up to 20 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus
Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and other physical exertion
Must be able to talk, listen and speak clearly on telephone
Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a motor vehicle

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