Medical Billing Specialist

General Job Summary: Promotes the Companies mission to provide patients with premier orthopedic care while focusing on their individual needs. Responsible for ensuring timely claim submission, follow-up with no response from payers, payer rejections, correspondence, and appealing denial.

Essential Job Functions

• The ability to remain friendly and professional through communication with patients, providers, clinical staff, payers, and outside agencies through telephone, electronic, and written correspondence.
• Manages multiple work queues for an assigned portion of the Accounts Receivable (A/R) daily on registration, claim edits, aging, and denials, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments.
• Assists with verification of benefits information to determine coordination of benefits via phone, email, or online portal.
• Analyze EOB’s and construct appropriate, timely responses to insurance carriers based on claim adjudication.
• Collaborates with manager, coordinator, and director to report denial trends to ensure proper claim resolution.
• Experience with variety of billing issues involving payers (Medicare, Medicaid, private insurance, worker’s compensation) including forms, coding compliance and reimbursement guidelines
• Thorough knowledge of medical terminology, managed care financial agreements; CPT, HCPCS, and ICD-10 codes.
• Handle billing calls and answer telephone calls as needed.
• Review credit balance accounts.
• Demonstrates superior interpersonal relationship skills necessary for developing and maintaining positive professional relationships with patients, peers, providers, clinical departments, the management team, and payer organizations through telephone, electronic and written correspondence.
• Ensure compliance with all guidelines set by government programs, and the Companies policies, such as federal regulations, HIPPA, and the No Surprises Act.
• Takes initiative in performing additional tasks that may be necessary or in the best interest of the practice.

Requirements

Education/Experience

• High School Diploma or equivalent.
• Associate’s Degree in Coding/Billing or minimum of two years medical billing experience is preferred.
• Collections or medical billing experience with an understanding of HCPCS, ICD-10 and medical terminology is preferred.

Other Requirements: Must be customer service oriented with a team environment focus. Schedules may change as department needs change, including overtime and weekends.

Performance Requirements

Knowledge

• Knowledge and application of the Companies Mission, Vision and Values.
• Medical billing terminology required.
• CPT and ICD-10 coding knowledge preferred.
• Knowledge of medical billing/collection practices.
• Knowledge of medical terminology and anatomy.
• Knowledge of insurance filing and payment posting techniques.
• Knowledge of basic medical coding and third-party operating procedures and practices.
• Knowledge of electronic health records and practice management systems.
• Knowledge of current professional billing and reimbursement procedures preferred.

Skills

• Skilled in attention to detail.
• Skilled in organizing.
• Skilled in grammar, spelling, and punctuation.
• Skilled in communicating effectively with providers, staff, patients and vendors.
• Strong communication skills in a professional manner during stressful and sensitive situations with patients of all ages.

Abilities

• Ability to problem-solve and the ability to interpret and make decisions based on established guidelines.
• Ability to work on a team while maintaining positive and professional relationships.
• Ability to multitask and handle stressful or difficult situations with professionalism.
• Ability to analyze situations and respond in a calm and professional manner.

Equipment Operated: Standard office equipment.

Work Environment: Medical office environment.

Mental/Physical Requirements: Involves sitting and viewing a computer monitor approximately 90 percent of the day. Must be able to use appropriate body mechanics techniques when making necessary patient transfers and helping patients with walking, etc. Must be able to remain focused and attentive without distractions (i.e. personal devices). Must be able to lift up to 30 pounds.