Billing Specialist

4 weeks ago

Red Bluff, United States Red Oaks Medical Group Inc Full time
Description

Job Title:Billing Specialist

Department: Business Office

Reports to: Business Office Supervisor/Revenue Cycle Manager

Organizational Peers: Business Office Staff

Supervisory Responsibilities: None

Position Details: Non-Exempt, Full Time, 40 hours/week

Pay Scale: $20-24/hr

Summary of Duties:Responsible for gathering charge information and entering into the data base, completing all of the billing processes, filing insurance claims, and working the aged accounts.
Essential Job Responsibilities:
  1. Reconciles account receivable claims using Athena Health electronic health records (EHR)
  2. Reconciles outstanding balances to determine appropriate course of action for various payers including Medicare, Medi-Cal, Worker's Comp.
  3. Traces and appeals underpaid, and/or erroneously paid or denied claims with appropriate documentation according to the payer requirements.
  4. Verifies and adjusts accounts according to payer or program specifications.
  5. Performs collection actions and resubmits claims to insurance companies after corrections to minimize days in accounts receivable.
  6. Accurately documents claim issues.
  7. Prepares adjustments such as refunds, contractual differences, and write-offs for approval and processing.
  8. Audits, communicates and follows up with providers and staff to provide guidance in correcting errors related to denied or unpaid claims on continuing basis.
  9. Identifies and resolves issues with patient/payer billing issues and complaints.
  10. Continually strives to promote and maintain exceptional internal and external customer service.
  11. Monitors payer websites for medical policy benefit changes. Communicates changes to supervisor and staff.
  12. Reviews bulletins, newsletters and periodicals and attends workshop to stay abreast of current issues, trends and changes in laws and regulations governing claims, processing, coding and documentation.
  13. Provides suggestions to improve daily collection workflows and inefficiencies.
  14. Demonstrates working knowledge of ICD-10, CPT and HCPCS codes along with HIPAA laws and LCD/NCCI edits
  15. Complies with all company policies and procedures.
  16. Provides back up and support to team members as necessary.
  17. Works projects as assigned by management.
  18. Other duties as assigned.
Performance Requirements:Knowledge:
  1. Knowledge of billing practices and clinic policies and procedures.
  2. Knowledge of coding and clinic operating policies.
  3. Knowledge of medical terminology.
  4. Knowledge of insurance industry.
  5. Knowledge of grammar, spelling, and punctuation.
Skills:
  1. Skill in establishing and maintaining positive, effective, internal and external working relationships.
  2. Skill in written and verbal communication.
  3. Skills in organization.
Abilities:
  1. Ability to understand and interpret policies and regulations.
  2. Ability to prepare documents in response to complaints and inquiries.
  3. Ability to accurately enter data.
  4. Ability to examine documents for accuracy and completeness.
  5. Ability to read, understands, and follows oral and written instruction.
  6. Ability to sort and file materials correctly by alphabetical or numeric system.
  7. Ability to communicate effectively and work with others
  8. Ability to multitask.


Education: High school graduation or GED.
Experience: Preferred minimum of one year billing experience in health care organization

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