MEDICAL BILLING SPECIALIST

This position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third-party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilities.

General responsibilities

• Able to perform accounts receivable collection activities timely and accurately including prioritizing subtasks.
• Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days.
• Accurately post all insurance payments by line item.
• Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely*
• Collects on outstanding claims from third-party payers according to department benchmarks.
• Works on special billing projects as assigned by the Billing Supervisor in conjunction with other billing responsibilities.
• Contact appropriate departments and eligibility systems to obtain necessary information for billing purposes.
• Responds efficiently and accurately to denials received. Ensures necessary information is obtained and resubmitted as quickly as possible.
• Documents the practice management system to reflect the current billing status of each patient account to ensure an audit trail of all account activity.
• Accurately documents reasons for denials that cannot be re-billed, and communicates such information to Billing Supervisor for follow-up.
• Processes patient, payer, and employee interactions within the guidelines set for the department.
• Responds professionally and timely to patient calls and third-party payer calls.
• Meets professional behavior expectations as evidenced by compliance with the following standards:
• Meets all attendance and punctuality requirements to ensure proper coverage and quality service
• Professional and appropriate dress as required by the position
• Demonstrates an ability to resolve interpersonal and professional conflicts appropriately
• Ability to formulate decisions and make judgments that are demanding and interpretative
• Keeps all matters related to the organization confidential in compliance with confidentiality policy
• Performs other duties as assigned related to revenue cycle management.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear.
• The employee frequently is required to stand, walk, sit; use hands to handle or feel; reach with hands and arms; and stoop, kneel, or crouch.
• The employee may occasionally lift and/or move up to 25 pounds.
• Specific vision requirements include the ability to see at close range.
• Fine hand manipulation.

Education and/or Experience

Required:

• High school diploma
• Minimum of four (4) years experience working Accounts Receivables
• Must know medical terminology
• Must have knowledge of outpatient billing procedure for third party payers, medical terminology, CPT coding, ICD9 coding, and completing UB92 and HCFA claim forms
• Computer experience is essential, including, but not limited to practice management software, word processing, and spreadsheet applications.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.

Preferred:

• CCS or CPC certification
• Some college or other technical school training

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to maintain confidentiality in all matters.
• Ability to resolve interpersonal and professional conflicts appropriately.
• Ability to formulate decisions and make judgments that are demanding and interpretative.
• General computer proficiency.
• Proficient in Medical terminology.
• Ability to type 30 wpm and use 10-key adding machine.
• Ability to provide excellent customer service.
• Ability to communicate effectively with diverse populations.