Overview

Analyzes, investigates, and resolves claims/billing information and/or errors associated with the more complex inpatient/outpatient medical insurance claims. Ensures compliance with managed care guidelines and MMC organizational policies

Qualifications

Education:

• Education equivalent to graduation from high school or GED is required.

Experience:

• Two or more years as a Billing Specialist (or comparable medical claims/billing experience), with the technical knowledge to process all types of applicable claims and resolve errors and complex issues associated with them.

Other Knowledge/Skills/Abilities:

• Demonstrates thorough knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD-9 CM) coding, and hospital billing claim form UB04 is required.
• Demonstrates a comprehensive knowledge of the electronic billing system and key contract billing guidelines and possess the ability to train others on the entire billing process.
• Basic working knowledge of personal computers and their associate user software is required. Experience with Microsoft Office products Word and Excel is preferred.
• Ability to work within the guidelines of defined managed care contract policy provisions and company procedures.
• Demonstrates ability to work successfully with internal customers and external contacts is required.
• Possesses a highly-developed detail orientation, critical thinking, and problem solving ability.
• Demonstrates excellent oral and written communication, keyboarding, and basic math skills.
• Demonstrates ability to work unsupervised as well as the ability to work in a group setting.

Responsibilities

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.