JOB DESCRIPTION

Would it excite you to...

· Be part of a team that’s like a fun family who works hard and plays hard

· Work somewhere that values personal AND professional goals

· Be appreciated for going above and beyond

· Have your ideas truly be heard

If you’re thinking, “YES! That’s me!”, keep reading…

Do these resonate with you…

· Can you be pushy with insurance companies over the phone?

· Do you know the CMS 1500 form by heart?

· Have you previously been in a Medical Reimbursement position?

If you said "yes" to all of these questions, you may be the next team member we're looking for!

POSITION SUMMARY

The Medical Billing Specialist is responsible for evaluating medical insurance cases that are denied coverage and researching whether the case merits an appeal. They support the billing department in meeting expectations regarding efficiency, privacy maintenance and quality of decision making. They initiate follow-up phone calls on accounts following departmental policy and procedure and best-practices. It is expected that they project a professional company image through in-person and phone interactions.

PRINCIPLE ACCOUNTABILITIES

Review patient accounts to determine whether all relevant information has been submitted

Identify and report payer denial, payment; recoupment trends and/or out of network errors with carriers to designated associate

Manage the flow and subsequently evaluate, research and process all appeals, grievances and provider review requests according to payer specific guidelines

Conduct appropriate investigation of all appeals

Interacts with payers to resolve outstanding / denied claims issues, sends statements and makes collection calls

Prepare appropriate written documentation and maintain necessary files

Initiate follow up phone calls on all necessary accounts

Follow up on all written and telephone correspondence

Document appropriate follow up notes on accounts and upkeep of any daily spreadsheets required by supervisor

Notify leadership of, and respond to, additional documentation requests (ADR), audits, and/or post payment review

Scan all documents relating to the patient/claim into EHR

Show work to maintain accountability and identify trends

Additional duties as assigned

JOB REQUIREMENTS

EDUCATION: High School Diploma or equivalent. Bachelor’s degree preferred
EXPERIENCE: 3 years accounts receivable experience in the medical field required. Experience with medical terminology and insurance industry and out-of-network. 
SKILLS: Ability to prioritize and handle multiple tasks in a changing work environment. Excellent written and verbal communication skills. Ability to work independently and on a team. Ability to interpret an Explanation of Benefits and take additional and necessary steps towards payment. Familiarity with Microsoft applications and database software. Strong attention to detail. Must be proficient with CPT, ICD-10 and HCPCS coding.

WORKING CONDITIONS
Working conditions are normal for an office environment.