PRINCIPAL JOB RESPONSIBILITIES
The Billing Specialist is expected to have a general knowledge of medical billing and follow-up procedures including: ensuring proper submission of all claims while meeting required billing deadlines, consistently following up on unpaid claims utilizing assigned tasks or aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with providers, clients, patients and fellow staff.
Principal Job Responsibilities:
• Ensures all claims are submitted with a goal of zero errors
• Verifies completeness and accuracy of all claims prior to submission
• Researches rejected and denied claims; reconciles with original claim; makes any necessary corrections; resubmits corrected claims, or submits appeals for reconsideration, as appropriate to the situation
• Makes necessary arrangements for medical records requests, completes additional information requests, etc., as requested by insurance companies
• Follows up with all insurance carriers on unpaid claims until the claims are paid and have reached a zero balance
• Prepares, reviews and sends patient statements for service amounts such as co-payments, deductibles and coinsurance
• Evaluates patient’s financial status and establishes budget payment plans; processes accounts to collections for non-payment, as required; follows up and reports status of delinquent accounts
• Communicates effectively with providers and patients regarding claims/billing questions or complaints
• Maintains goodwill with both patients and insurance companies; responds in a timely manner and ensures all issues are resolved according to established guidelines and required laws and regulations
• Regularly meet with Director to discuss and resolve reimbursement issues or billing obstacles
• Completes work with excellent attention to detail to ensure compliance with departmental/company/HIPAA standards
• Maintains strict confidentiality of information at all times
• Performs other duties as assigned
• High school diploma or equivalent
• Minimum 2 years of experience in healthcare billing
• Excellent attention to detail, problem solving and critical thinking
• Must have a team player mindset with adaptability to monitor own work
• High degree of professionalism and customer service
• Excellent written and oral communication skills
• Working knowledge of Microsoft Word and Excel
• Medical Billing Experience – REQUIRED: 2 years
• Microsoft Excel – REQUIRED: 2 years
- Ten (10) years HIM, Business Office or related Revenue Cycle experience in a Healthcare related field.
- Six (6) years of management experience.
- Bachelor’s Degree in Business Administration or a health related field preferred.
- Knowledge of Medicare, Medicaid, State and Federal guidelines.
- Knowledge of standard medical billing system configuration.