Job Title: Medical Billing Specialist
Department: Business Office
Reports To: Business Office Manager
This position uses medical coding procedures and patient records to ensure patient claims are submitted timely and accurately. This includes accurately posting payments and entering adjustments on patient accounts, following up on insurance rejections and denials by filing corrected claims, fulfilling insurance requests and filing appeals with insurance providers as necessary.
This position also assists patients with their understanding of medical benefits by using strong communication skills with patients, other medical staff and health insurance providers and updates internal databases that organize patient records, billing details and registration forms.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include:
- Enters patient information, such as insurance ID, diagnosis, procedure codes and modifiers, necessary to process insurance claims in Advanced MD and ensures accuracy.
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form.
- Answers patient questions regarding patient balances, copays, deductibles, write-offs and more.
- Explains why certain services are not covered and resolves patient complaints.
- Follows up with insurance providers regarding unpaid and rejected claims; Resolves issues and re-submits claims.
- Prepares appeal letters to insurance carriers and collects necessary information to appeal denied claims.
- Works with patients to establish payment plans for past due accounts in accordance with provider policies.
- Provides necessary information to the collection agency for delinquent accounts.
- Posts insurance and patient payments using Advanced MD.
- Performs “soft” collections for patient past due accounts by phone and US mail.
- Prepares and submits secondary claims upon processing by primary insurer.
- Follows HIPAA guidelines in handling patient information.
- Creates insurance or patient aging reports using medical practice billing software and uses these reports to identify unpaid insurance or patient balances.
- Understands managed care authorization and coverage limits, such as the number visits.
- Verifies patients benefit eligibility and coverage.
- Other duties as assigned.
The requirements listed below are representative of the knowledge, skill, and/or ability required to successfully perform this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Ability to read, write and communicate effectively and clearly with patients, other medical staff and health insurance providers in the English language.
- Ability to perform basic math calculations.
- Ability to recognize problems, collect data, establish facts, draw valid conclusions, and provide possible solutions to physicians and managers and alert them of potential problems.
- Knowledge of and ability to look up ICD-10, CPT and HCPCS codes.
- Knowledge of medical terminology and consistent application of medical documentation requirements.
- Ability to follow policies and procedures for compliance, medical billing and coding.
- Ability to sit for an extended period.
- Ability and willingness to travel to and from ALL clinic locations.
- Ability to detect Remittance Advice and payment entry coding errors and perform modifications needed to correct rejected claims in a timely manner.
- Skilled in establishing and maintaining effective internal and external working relationships.
- Ability to provide great customer service and deal courteously with patients when assisting them with obtaining and understanding medical benefits.
- Ability to operate essential office equipment, including multi-line phone, computer, fax machine, scanner and photocopy machine.
- Ability to type and enter data with proficiency and accuracy.
EDUCATION and/or EXPERIENCE
High School diploma is required. Previous experience in the health insurance sector preferred. Completion of an educational program (Certified Professional Coder (CPC), Ophthalmic Coding Specialist (OCS)) is preferred but not required.
Climate controlled office space.