Medical Billing Specialist

The Medical Billing Specialist is responsible for posting charges and receiving payment for all medical services rendered by Pediatric Associates of Alexandria. Employees in this role are held accountable for managing their accounts throughout the entire collections process. Prompt submittal and follow-up of all claims are essential for success. Persistency is vital! Errors will result in slow payment and/or reduced and lost revenue to PAA. Electronic Medical Records (EMR) experience preferred; our practice uses eClinicalWorks(ECW).

Duties & Responsibilities Include But Not Limited To:

· Post insurance, patient and credit card payments for all assigned payers on a daily basis.

· Complete claim forms, submit patient statements and claims.

· Manage the claims submission process for all assigned payers.

· Ensures all claims are submitted with minimal error rate.

· Maintain a record of electronic claims/Patient Statements to include transmission confirmation reports.

· Follow up on ALL claims; via website, phone and/or correspondence, regarding reimbursement.

· Facilitate Steps necessary to ensure ALL claims are paid in a timely manner.

· Monitor insurance payments to ensure the practice is paid accurately and according to payment schedules.

· Monitor self-pay and uninsured patient accounts; continuous follow-up and collection as necessary.

· Works with management to identify payer trends and non-payment issues.

· Research / obtain incomplete or additional information for billing requirement as needed.

· Keep abreast of any change in policy that affects the filing of claims and timeliness of payment.

· Attend in-service given by plan representative to maintain an understanding of billing procedures.

· Establish and maintain written guidelines about billing requirements of all insurance companies.

· Run weekly and/or monthly reports.

· Analyze and process adjustments as necessary.

· Process and document refund requests.

· Follow up, Resubmit and or appeal unpaid claims and process accounts as needed for bad debt.

· Demonstrate legal and ethical responsibilities to protect patient confidentiality.

· Collect account balance and establish a payment arrangement as needed.

· Identify patients who qualify for hardship services.

· Assist patients with an explanation of payer reimbursement and account status.

· Attend required staff meetings and continuing education courses as requested.

· Self-motivated, organized, detail-oriented, and a team player.

· Perform all other tasks as requested by the Manager.

Performance Standards
Employee performance evaluation will include, but limited, to the following measures:

· Professionalism not only with coworkers but telephone contact with clients.

· Compliance of all duties and responsibilities.

· Accuracy and timeliness of data entry and error resolution.

· Compliance with all company, state, federal and carrier rules, and regulations.

· Attendance & Tardiness.

· Ethical Standards and Honesty.