Benefits :

Paid time off

The Billing Specialist is responsible for calculating and collecting payments for services.

JOB DESCRIPTION

• Submits medical claims to insurance companies and payers such as Medicare and Medicaid, Community Care, Molina Healthcare, etc.
• Update patient data, develop payment plans, and prepares invoices.
• Ensure that patients and insurance providers are billed quickly and accurately.
• Reviewing patient bills for accuracy and completeness and obtaining any missing information.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates)
• Apply knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly (e.

g., HIPAA, PPACA / Health Care Reform, state-specific regulations / grievance procedures, TAT)

• Following up on unpaid claims within standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances.
• Reviewing accounts for insurance accuracy.
• Responsible for reviewing, researching, investigating, negotiating, processing and adjusting all claims including denied claims as necessary.
• Setting up patient payment plans and work collection accounts.
• Participate in the on-call rotation to ensure holiday, weekend and after hour coverage.
• Back fill position of Personal Care Worker, Staffing Scheduler and Processor.

Knowledge / Special Skills / Abilities Needed :

• Knowledge of ICD-10 and CPT coding.
• Strong computer skills with proficiency in software applications, such as Word, Excel, and Electronic Medical Records.
• Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.
• Ability to work effectively in a team environment.
• Ability to gather and analyze statistical data and generate reports and to plan, coordinate and administer complex administrative systems and processes.
• Ability to work with frequent, established deadlines.
• Ability to develop, plan, and implement short- and long-range goals.
• Ability to be very organized and focused on regulations and billing needs.

This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as management may deem necessary from time to time)

Last updated : 2024-05-10