Medical Billing Lead
3 weeks ago
Department: Billing
Position: Medical Billing Lead
Employee Category: Non-Exempt
Reporting Relationship: Manager of Revenue Cycle Management
Character First Qualities:- Decisiveness: The ability to recognize key factors and finalize difficult decisions.
- Dependability: Fulfilling what I consented to do, even if it means unexpected sacrifice.
- Flexibility: Willingness to change plans or ideas without getting upset.
- Patience: Accepting a difficult situation without giving a deadline to remove it.
- Tolerance: Accepting others at different levels of maturity.
The Medical Billing Lead is responsible for reviewing and scrubbing claims, filing third-party claims, self-pay patient billing, and answering billing questions from patients and staff. They are also responsible for the administration of special programs as assigned.
Primary Duties and Responsibilities- Reviews assigned claims daily to ensure accuracy prior to claim submission.
- Reviews work of other Billing staff and answers questions when needed.
- Assists with training of new and existing staff.
- Reviews documentation on self-pay claims to ensure that the appropriate discount is applied.
- Makes billing corrections and adjustments to claims as appropriate to ensure prompt payment and accuracy of balance.
- Validates the correct payer for claim as well as verifies patient eligibility when in question.
- Contacts patients for missing information or clarification of documentation.
- Requests documentation and/or information required to process claims. Scans and uploads documentation and information to patient accounts as applicable.
- Submits claims to clearinghouse daily.
- Processes secondary and tertiary claims accurately and timely to ensure payment.
- Coordinates with the Claims Resolution Specialists to assist in investigating denied claims and credit balances and coding corrections.
- Completes rejection and rebill requests.
- Follows up on pending claims and works to resolution.
- Assists with patient phone calls regarding balances and benefits; advises patients of deductibles and co-payment status.
- Assists patients with payment arrangements by coordinating with a Collection Specialist. Issues individual statements when necessary on patient accounts.
- Assists the front staff with billing and eligibility related questions.
- Keeps abreast of the variety of programs offered at each site and applies benefits correctly to patient charges.
- Maintains billing for special programs as assigned.
- Produces itemized billing requested by law firms or other agencies.
- Processes DLO invoices monthly and sends all requested information from accounts.
- Creates daily deposit slips on self-pay and private pay accounts.
- Collects credit card payments from patients and posts to respective accounts.
- Keeps current with dental, behavioral health, and vision claims and processes.
- Reports trends to the Manager of Revenue Cycle Management for review and action.
- Meets established daily, weekly, monthly, and annual deadlines.
- Upholds Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information.
- Follows written and verbal instructions from the Manager of Revenue Cycle Management.
- Exhibits professionalism in communication with patients, clients, insurance companies, and co-workers.
- Participates in special projects as assigned.
- Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to providing care that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable.
- High school diploma or GED.
- Five years of experience in third party billing in a Family Practice setting.
- Experience filing third party claims and reports in a timely manner.
- Experience interacting and communicating effectively with individuals at various levels, often in sensitive situations.
- Basic knowledge of CPT codes and monitoring coding changes.
- Basic knowledge of medical terminology and protocols.
- Basic knowledge of coding and anatomy.
- Mastery of critical thinking, analytics, problem-solving, and sound decision-making skills.
- Proficiency with Microsoft Office and practice management software systems.
- Experience assisting and supporting others professionally and respectfully.
- Bilingual (English/Spanish).
- Must be able to lift 25 pounds.
- Must be able to sit for extended periods of time.
- Must have excellent concentration ability.
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