JOB SUMMARY

Medical Billing Specialist performs various duties for the billing department and physicians including billing, coding, payment posting, accounts receivable, insurance company relations, appeals, and collections. Medical Billing Specialist duties include the performance of billing and collection functions for the practice. The primary responsibility is oversight of charges, payments, accounts receivable, and appeals. Must have a thorough knowledge of ICD-10 and CPT coding, be familiar with insurance contracts, fee schedules, capitation, appeals, and billing. Medical Billing Specialist monitors insurance payments as they correlate to fee schedules to ensure accuracy and follows up with insurance companies to resolve inaccuracies. The medical Billing Specialist is tactful and candid in the performance of duties so that patient privacy is protected at all times. Good judgment, prudent leadership, organizational ability, initiative, attention to detail, and the ability to be self-motivated are especially important when working as a Medical Billing Specialist.

REQUIRED EDUCATION

Minimum of High School Diploma or General Education (GED) degree required. Associates Degree, or an equivalent amount of education and training preferred.

EXPERIENCE AND QUALIFICATIONS

At least five years experience as a billing representative in a medical setting. Certification through a Professional Coding program such as AAPC or AHIMA, preferred.

SKILLS

Medical terminology.

Computer proficiency and ability to quickly learn new applications.

Advanced working knowledge of billing operations including charges, coding, payments, adjustments, insurance claims, and appeals.

Advanced and current knowledge of CPT, HCPCS, and ICD-10 coding.

Current knowledge of Fair Collections laws. o Current knowledge of insurance payer coding, capitation, contracting, and reimbursement guidelines.

Ability to identify, initiate, implement and manage billing practices, policies and procedures.

Expert knowledge and experience in health information system management, including billing and medical record applications.

Professional demeanor and recognition of privacy considerations for patients and families.

Ability to exercise initiative, problem-solving, and decision-making.

Demonstrated customer service-oriented attitude and behavior.

1-2 year experience worker's compensation experience highly preferred.

PHYSICAL REQUIREMENTS MAY INCLUDE

Spend approximately 6-7 hours per day sitting at a desk

Entering data on a computer terminal and talking on the telephone

Spend approximately to 1 hour per day of intermittent walking.

Hear and speak clearly by telephone

Meet frequent deadlines and tight schedules Lift 1 - 5 pounds, primarily paper reports, and filing

Frequent preparation of paper insurance claims and appeals for mail submission

Frequent sitting

Frequent keyboarding

Frequent mousing

Carry up to 5 pounds

REQUIRED EDUCATION

Minimum of High School Diploma or General Education (GED) degree required. Associates Degree, or an equivalent amount of education and training preferred.

EXPERIENCE AND QUALIFICATIONS

At least five years experience as a billing representative in a medical setting. Certification through a Professional Coding program such as AAPC or AHIMA, preferred.

SKILLS

Medical terminology.

Computer proficiency and ability to quickly learn new applications.

Advanced working knowledge of billing operations including charges, coding, payments, adjustments, insurance claims, and appeals.

Advanced and current knowledge of CPT, HCPCS, and ICD-10 coding.

Current knowledge of Fair Collections laws. o Current knowledge of insurance payer coding, capitation, contracting, and reimbursement guidelines.

Ability to identify, initiate, implement and manage billing practices, policies and procedures.

Expert knowledge and experience in health information system management, including billing and medical record applications.

Professional demeanor and recognition of privacy considerations for patients and families.

Ability to exercise initiative, problem-solving, and decision-making.

Demonstrated customer service-oriented attitude and behavior.

PHYSICAL REQUIREMENTS MAY INCLUDE

Spend approximately 6-7 hours per day sitting at a desk

Entering data on a computer terminal and talking on the telephone

Spend approximately ½ to 1 hour per day of intermittent walking.

Hear and speak clearly by telephone

Meet frequent deadlines and tight schedules Lift 1 - 5 pounds, primarily paper reports, and filing

Frequent preparation of paper insurance claims and appeals for mail submission

Frequent sitting

Frequent keyboarding

Frequent mousing

Carry up to 5 pounds