Denials Specialist/Medical Biller (Hybrid)

Digestive Health Specialists, P.A., a leading gastroenterology group based in Winston Salem, is currently recruiting for a Billing Specialist to join our team. We are a well-established and growing practice; founded originally in 1979 and have grown to serve our patients now in 5 locations. Patients choose our practice for our experienced providers and staff who provide friendly, compassionate, high-quality and affordable care. No weekends, nights or call would apply for this position.

Job Overview:

Responsible for the reimbursement and/or resolution of patient insurance account balances with the goal of working accounts to resolution.  This role performs account management and analysis; as well as complete, timely and accurate follow up of insurance (hospital, physician or ASC) account balances with the objective of optimizing insurance reimbursement. 

Primary Job Duties:

• Maintain a professional and compassionate demeanor in all interactions with our patients. 
• Work all insurance follow up (hospital, physician and ASC), which includes a focus on claims that have been denied, need more information or are paid incorrectly by insurances.
• Interacts with, and leverages, external and internal resources to overcome barriers, problem solve and ultimately resolve insurance account balances.
• Communicate effectively with patients, physicians, contracted insurances and third party payers.
• Review and determine appropriate actions for claim follow up, including but not limited to, appeals, insurance website inquiries, calls to insurance customer service representatives, etc.
• This role is accountable for understanding and reconciling insurance practices such as: confirming a claim has been received, validation of denied charges, and collaboration with site resources to ensure denials are appealed timely and submitting information requested by insurance companies for denied claims.
• Updates insurance information and routinely adds account notes to each account worked.
• Identify questionable accounts/bills, problematic payers or unusual situations and brings to the RCM.
• Identify and escalate any payer trends identified to resolve and/or mitigate issues.

Secondary Job Duties:

• Provide feedback to the RCM to address any issues related to insurance reimbursement and claims resolution.
• Update personal job knowledge by participating in educational opportunities; reading professional publications, etc.
• Possesses a thorough knowledge of DHS billing procedures, payer policies, CMS guidelines and general compliance principles.
• Abides by all DHS policies and procedures and maintains excellent attendance.
• Perform other duties as needed or assigned by Revenue Cycle Manager.

Hybrid Work Environment Expectations:

• This position may be eligible for a hybrid work arrangement based on departmental needs, job performance, and management approval. Employees approved for remote work are expected to maintain a professional and productive work environment while working from home.
• Reliable high-speed internet access is a requirement for this role. Employees are responsible for ensuring they have dependable internet service capable of supporting all required systems, applications, and communication platforms necessary to perform their job duties effectively.
• In the event of internet outages, connectivity issues, power disruptions, or other circumstances that prevent an employee from performing their duties remotely, employees may be required to report onsite to continue working, unless otherwise approved by management. Failure to report onsite when able may be treated in accordance with DHS attendance and scheduling policies.
• Hybrid and remote work privileges are subject to ongoing review and may be modified or revoked based on operational needs, performance expectations, or policy compliance.

Qualifications:

• High school diploma or equivalent
• 3-5 years medical billing experience required
• CPB preferred or equivalent experience with advanced knowledge of medical terminology, ICD 10, CPT/HCPCS codes and HIPAA laws.

Skills and Proficiencies:

• Ability to interpret EOBs and navigate insurance policies.
• Proficient in Epic Resolute Billing
• Well-organized with attention to detail
• Proficient with technology, spreadsheet management skills with the ability to analyze trends.
• Excellent organizational skills, ability to manage multiple priorities and responsibilities.
• Ability to establish and maintain effective working relationships with team members, clinic staff and patients
• Have a desire and dedication to work with self-discipline
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations
• Ability to sit for long periods.  Work required walking, bending, standing, sitting, and reaching