Medical Billing Specialist

JOB SUMMARY: The primary purpose of this position is to facilitate all aspects of non-clinical patient services, with a focus on insurance processing specific to claim denials and follow up. The function of this position is to provide all facets of services related to Business Services. Position will be staffed during clinic hours and is fully remote.  Training will be completed remotely.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Review and process daily and monthly work queues of aging and reports to ensure claims are being processed in a timely manner.
2. Answer and respond to patient inquiries related to claims processing.
3. Maintain all records for assigned insurance encounter types.
4. Effectively communicate with insurance payers by insurance portal, phone and/or written correspondence. 
5. Review accounts for correct insurance loading and insurance filing.
6. Review accounts for proper application of payments, adjustments, denials, refunds and or credit balances.
7. Review claim status messages in electronic systems and make appropriate changes.
8. Appropriately submit corrected claims and appeals for unpaid and/or denied charges according to health plans policy requirements and AUC standards.
9. Request claim review from coding, when appropriate.
10. Monitor assigned health plan news and communicate appropriately to the group on any policy and procedural changes that impact practice policies.
11. Demonstrate the ability to recognize trends with claim processing and denials.

SUPPLEMENTAL DUTIES AND RESPONSIBILITIES:

1. Maintain confidentiality.
2. Establish and maintain positive working relationships.
3. Work independently with minimal instruction in team environment. 
4. Attend training sessions, in-services, departmental and facility meetings.
5. Adheres to the philosophy and provides comprehensive care according to a patient centered healthcare clinic.
6. Perform other duties and responsibilities as required or assigned by the Revenue Cycle leadership.
7. Ability to multi-task and meet daily, weekly and monthly deadlines.

WORKING CONDITIONS:
1.    Subject to interruptions, imposed deadlines and frequent problem-solving activities.
2.    May be subject to hostile and emotionally upset patients, staff, and personnel from other agencies.
3.    Standard Office Environment.

PHYSICAL DEMANDS:

1. Abide by ergonomic recommendations of the position. 
2. Must possess sight/hearing senses or use prosthetic devices that will enable these senses to function adequately. 
3. Sit for several hours. 
4. Repetitive motions involving use of phone and keyboard. 

EDUCATION:

• Minimum: High School Diploma or equivalent
• Desired: Post-secondary education.

EXPERIENCE:

• Minimum: 1-2 years in Healthcare Business Office.
• Desired: 2-4 years Insurance Billing and Accounts Receivable

KNOWLEDGE:

1.    Advanced knowledge and understanding of remittance advice (EOB) statements.
2.    Proficient working knowledge of ICD10 and CMS billing guidelines.
3.    Knowledge of PC, Windows and Microsoft Office specific to Excel.
4.    Knowledge of medical terminology and healthcare insurance. 
5.    Good grammar, spelling and communication skills. 

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