Medical Billing Specialist

JOB PURPOSE:

Assure timely and accurate submission of hospital claims (electronic and paper) to ALL insurance carriers.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Identify and bill secondary or tertiary insurances.
• Work rejected claims for timely re-submission.
• Assure claim contains pertinent and correct information for processing.
• Research previously processed claims when needed.
• Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims and report to Revenue Cycle Manager.
• Coordinate and resolve any and all issues related to claims processing with the appropriate departments as required.
• Research, resolve, and respond to claim re-submission appeals and inquires for Medicaid.
• Reviews system generated work list, reports and/or aged trial balances to resolve accounts which have not been paid in the appropriate time frame, based on specific CMS and Fiscal Intermediary guidelines.
• Reviews Medicaid payment denials and discrepancies identified through Remittance Advices denials and takes appropriate actions to correct these accounts.
• Identifies and processes refunds to patients and insurance companies.
• Documents account activities in an accurate and timely manner in accordance with quality standards.
• Follow all applicable Medicare and Medicaid regulations including HIPAA.
• Applies high level of knowledge of respective insurance billing regulations and guidelines. Researches these guidelines when required on payer websites where available.
• Ensures compliance with all state and federal billing regulations and reports suspected compliance issues to their respective Leads/Supervisors/Managers.
• Help create, implement, and improve processes for the revenue cycle team.
• Support management on special projects.
• Other duties as assigned.

BEHAVIORAL STANDARDS:

• The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
• Exhibit positive customer service behavior in everyday work interactions.
• Demonstrate a courteous and respectful attitude to internal workforce and external customers.
• Communicate accurately and appropriately.
• Handle difficult situations in a discreet and professional manner.
• Hold self-accountable for professional practice.
• Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
• Keep current with literature regarding changing practices, interventions and best practices in patient care.
• Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
• Act as a preceptor as requested.
• Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required.
• Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

EDUCATION:

• High school diploma or equivalent.
• At least two years of hospital billing experience.

CERTIFICATION/LICENSURE:

Certifications preferred but not required:

• Certified Revenue Cycle Specialist (CRCS) from AAHAM
• Certified Revenue Cycle Representative (CRCR) from HFMA

PHYSICAL REQUIREMENTS:

• In order to perform the essential functions of this position, you must be able to Sit, Walk, Stand, Use your hands, Reach, Talk, and Hear.
• Must be able to lift or exert energy up to 25 pounds.
• Close vision is required, distance or clear vision at 20 ft. or more and the ability to observe an area that can be seen to move up and down or left and right.