Job Title: Billing Specialist FLSA: Non-exempt
Reports: Billing Manager Location: Corporate Office
Version: 001 Last Revision:
Job Summary
Submits the claims to insurance companies for payment to the provider for services rendered. Takes the data provided by the medical coders and uses it to compile and submit claims to insurance companies and then subsequently bill patients. Performs other work associated with the billing process.
Essential Duties and Responsibilities
- Operates databases and EMR software.
- Uses coded data to produce claim information.
- Enters information necessary for insurance claims such as patient, insurance ID, diagnoses and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
- Ensures claims have the appropriate modifier, diagnosis pointer, billing and rendering provider and selected fee schedule.
- Monitors claims for missing information and authorization/control numbers.
- Ensures all claims are submitted with a goal of zero errors.
- Submits claims through to the clearinghouse or individual insurance companies electronically or via paper CMS-1500 forms.
- Updates the claim the MVA or employment related information for Worker’s Compensation claims, ensures these claims are printed and applicable progress notes are attached and mailed.
- Works through front-end claim denials at the clearinghouse level that have not been accepted and/or rejected by the payor.
- Resubmits non-adjudicated claims to the appropriate payor.
- Processes past due invoices and failed billing.
- Reviews claims for appropriate billing when denial is received by the payor and the account reps within the Accounts Receivable department have sent the claim back for further review.
- Assists in reviewing billing from reference labs and other sources.
- Completes work within authorized time to assure compliance of departmental standards.
- Other duties as assigned.
Education/Experience/Skills/Certifications
High school diploma or GED required. Minimum of 6 months’ medical office billing experience. Knowledge of clinical policies and procedures. Knowledge of medical terminology and insurance carriers. Knowledge of computer programs and applications. Knowledge of grammar, spelling and punctuation. Skilled in gathering, interpreting and reporting insurance information. Skilled in trouble-shooting insurance problems and claims. Skilled in written and verbal communication. Ability to identify claim problems and recommend solutions. Ability to sort and file insurance forms and associated information. Ability to work effectively with patients, employees and the public.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
Possible exposure to infectious/contagious disease, hazardous chemicals and materials, needle sticks, blood and body fluids.
I have received the job description of Billing Specialist and understand that the information above is not intended to be an exhaustive list of all duties, responsibilities, and skills required of this position.