The Medical Billing Specialist is a key member of the financial team at the Chicago Center for Sports Medicine & Orthopedic Surgery. This role is primarily responsible for ensuring accurate and timely processing of insurance payments, conducting appeals on improperly processed claims, and maintaining diligent follow-up on outstanding claims and denials. The Specialist will also assist with coding issues and patient inquiries regarding billing.

Key Responsibilities:

Payment Posting:

• Accurately post insurance payments from mail batches and electronic funds transfers (EFT) from various sources, including websites and ECW EFTs.
• Review and reconcile payment entries to ensure that all payments are accounted for and properly posted.

Claims Management:

• Conduct thorough follow-ups on all outstanding insurance claims to ensure timely reimbursement.
• Investigate and appeal underpaid or denied claims by gathering necessary documentation and submitting detailed appeals to insurance companies.
• Proactively manage the Payer Denied Bucket by reviewing and resolving denied claims from commercial insurances.

Appeals and Rejections:

• Handle mail batch rejections by reviewing the reason for rejection, correcting any issues, and resubmitting the claims.
• Track the status of appeals by monitoring the appeal bucket and performing regular follow-ups until the appeal is resolved.

Coding and Compliance:

• Assist with coding issues by reviewing and suggesting appropriate corrections to ensure accurate billing and compliance with medical coding standards.

Communication and Customer Service:

• Respond to patient inquiries, providing clear explanations of benefits and answering insurance-related questions.
• Ensure timely and professional responses to emails and voicemails related to billing inquiries.

Surgical and Commercial Billing:

• Handle billing for surgical procedures, ensuring accuracy and completeness of all claims.
• Manage commercial billing processes, including claim submission and follow-up.

Cross-Training and Collaboration:

• Be cross-trained and serve as a backup for various billing positions within the department, maintaining the flexibility to support different functions as needed.

Administrative Support:

• Complete actions and telephone encounters promptly, maintaining a high standard of patient service.
• Participate in special projects and perform additional duties as assigned by supervisors or management to support the billing department.

Qualifications:

• Associate or bachelor’s degree in finance, accounting, healthcare administration, or a related field is preferred.
• Certification in medical billing and coding is highly desirable.
• Minimum of 2 years of experience in medical billing, specifically in an orthopedic or similar specialty practice.
• Proficiency with medical billing software, preferably ECW (eClinicalWorks), and a solid understanding of EFTs.
• Knowledge of medical terminology, ICD-10, and CPT coding.
• Strong analytical skills and attention to detail.
• Excellent communication and customer service skills, with the ability to explain complex billing issues in understandable terms.
• Ability to manage multiple tasks and prioritize work to adhere to deadlines and patient service standards.

The Medical Billing Specialist at Chicago Center for Sports Medicine & Orthopedic Surgery is integral to our team, ensuring the practice's financial health through meticulous billing management and exceptional patient service. If you have a passion for healthcare finance and a commitment to excellence, we invite you to apply.