Title: Medical Billing Specialist

FTE: 1.0

Schedule: Monday to Friday, 8:00am to 4:30pm

Hybrid: Hybrid position; onsite for training period; after training period remote with one day per week onsite.

Holiday Rotation: None

Weekend Rotation: None

On Call Requirements:

POSITION SUMMARY

Responsible for duties such as claims submission, insurance follow up, posting insurance payments, reconciling, and balancing accounts, as well as preparing bank deposits. This position has direct contact with patients and insurance companies to resolve coverage and/or denial issues. They are responsible for researching and analyzing payments to ensure accuracy and following up with the insurance company regarding any discrepancies.

POSITION TECHNICAL RESPONSIBILITIES

CLAIMS SUBMISSION

1. Download electronic primary and secondary claims to electronic claims vendor.
2. Submit claims for reimbursement to insurance carriers.
3. Submit paper secondary claims.

INSURANCE FOLLOW UP/RESOLUTION

1. Follow up on unpaid claims and initiate insurance tracking report or worklist.
2. Correspond with insurance carriers clearly explaining claim problems for any claims which are not processed correctly.
3. Reconciles and resubmits denied claims to ensure proper reimbursement.
4. Audit problem patient accounts.
5. Have direct communication with patients regarding their accounts.
6. Follow up on all assigned accounts from within the billing systems.
7. Research and analyze accounts and payments; reverses balances to credit or debit if charges were improperly billed or if payments were incorrect.
8. Ensure that all conditions for payment receipt have been satisfied, which includes, but is not limited to accurate charges and financial class, authorization/certification/information, claims address, ICD-9 and CPT-4 coding, patient insurance eligibility, patient benefit coverage and patient responsibility.
9. Respond to all incoming correspondence and inquires from payers, patients, and other appropriate parties.
10. Initiate contact with patients as necessary.
11. Initiate recommendation and action plans for resolving accounts.
12. Evaluate accounts to determine any write-offs or corrections required, including duplicate charges.
13. Prepare refund requests for any monies due patient or insurance company.
14. Write appropriate notes in system for every account, including any action taken.
15. Handle in a professional and confidential manner all correspondence, documentation and files.
16. Review various reports to identify denials and edits; corrects claims, suggest actions plans to eliminate theses denials/edits in the future, and determines appropriateness for appeals.

POSTING/BALANCING

1. Edit, check and prepare payment receipts.
2. Enter payments on patient accounts in computer billing system.
3. Run, review and balance computerized receipt summary and make the daily bank deposit.
4. Post cash drawer money from clinics and balances cash drawers.
5. Prepare write-off requests for denied claims with cannot be appealed.

OTHER

1. Understand and follow regulations regarding insurance billing.
2. Elevate issues, as appropriate, to the supervisor
3. Meet production standards such as Business Office quality and quantity guidelines.
4. Support SPH core values, policies, and procedures.
5. Establish payment arrangements according to guidelines as requested by patients.
6. Prepare correspondence to patient/guarantor.

POSITION REQUIREMENTS

Education:

• Required: High School Degree or equivalent
• Preferred: Technical diploma in Medical Billing

Experience:

• Required: None
• Preferred: 1-3 years in a similar position

Licenses and Registrations:

• Required: None
• Preferred: None

Certification(s):

• Required: None
• Preferred: Completion of Certified Patient Accounts Technician (CPAT) program

BENEFIT SUMMARY

1. Competitive health and dental insurance options
2. Flexible paid time off to balance work and life
3. Retirement plan with immediate vesting and employer match
4. Free membership to our state-of-the-art fitness facility
5. Generous tuition reimbursement
6. Employer provided life and disability insurance
7. Free parking at facility

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