Medical Billing & Insurance Specialist

We are a small orthopedic medical practice seeking a dependable Medical Billing & Insurance Specialist to join our team.

This is not a dedicated medical coding position, and coding certification is not required. We are looking for someone with at least one year of medical billing and/or insurance experience who has a working knowledge of CPT and ICD-10 coding and understands medical insurance and claims.

The ideal candidate should be able to recognize when something does not look right, research the issue, and help determine what needs to be corrected. This person should also stay current on changes in insurance requirements, payer policies, billing rules, and relevant CPT/ICD-10 changes.

Because we are a small medical office, this is a varied position. In addition to billing and insurance responsibilities, all staff members help answer phones, assist patients and coworkers, and perform general office duties as needed.

Responsibilities:

• Review patient accounts, charges, and claims for accuracy and completeness
• Work billing queues and ensure claims are processed appropriately
• Prepare, review, and submit claims as needed
• Follow up on unpaid, rejected, and denied claims
• Research denials and assist with claim corrections, reconsiderations, and appeals
• Communicate with insurance companies regarding claims, denials, payments, and discrepancies
• Review insurance payments and adjustments for accuracy
• Identify and bill secondary insurance when appropriate
• Assist with patient billing questions, balances, and collection follow-up
• Maintain EOBs, payment records, and billing documentation
• Perform insurance eligibility and benefit verification as needed
• Obtain prior authorizations as needed, including assisting with imaging/procedure authorizations
• Complete benefit verification for hyaluronic acid (HA/viscosupplementation) injections, including coverage and authorization requirements
• Maintain working knowledge of CPT, ICD-10, and modifiers and research coding questions when necessary
• Recognize when a code, modifier, diagnosis, payment, claim, or insurance requirement appears incorrect and investigate
• Stay informed of changes to Medicare, commercial insurance requirements, payer policies, and billing/coding rules
• Identify recurring denials, reimbursement issues, or billing trends and bring concerns to management
• Work with providers, office staff, and outside RCM/billing resources to resolve billing issues
• Answer incoming telephone calls and assist patients or route calls appropriately
• Scan and maintain medical and billing documents
• Assist with various administrative and general office duties as needed
• Maintain HIPAA compliance and patient confidentiality

Qualifications:

• Minimum 1 year of medical billing, medical insurance, or related medical office experience
• Working knowledge of medical insurance, claims, CPT and ICD-10
• Coding certification is not required
• Ability to research and troubleshoot billing and insurance issues
• Strong attention to detail and organizational skills
• Comfortable communicating with patients and insurance companies by telephone
• Ability to multitask and work as part of a small office team
• Basic knowledge of medical terminology
• Good computer skills
• Orthopedic experience preferred, but not required
• eClinicalWorks (eCW) experience preferred, but not required

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