What are the responsibilities and job description for the Medical Billing Specialist position at Primus Ortho?
The Medical Billing Specialist is a key member of the financial team at the Chicago Center for Sports Medicine & Orthopedic Surgery. This role is primarily responsible for ensuring accurate and timely processing of insurance payments, conducting appeals on improperly processed claims, and maintaining diligent follow-up on outstanding claims and denials. The Specialist will also assist with coding issues and patient inquiries regarding billing.
Key Responsibilities:
Payment Posting:
- Accurately post insurance payments from mail batches and electronic funds transfers (EFT) from various sources, including websites and ECW EFTs.
- Review and reconcile payment entries to ensure that all payments are accounted for and properly posted.
Claims Management:
- Conduct thorough follow-ups on all outstanding insurance claims to ensure timely reimbursement.
- Investigate and appeal underpaid or denied claims by gathering necessary documentation and submitting detailed appeals to insurance companies.
- Proactively manage the Payer Denied Bucket by reviewing and resolving denied claims from commercial insurances.
Appeals and Rejections:
- Handle mail batch rejections by reviewing the reason for rejection, correcting any issues, and resubmitting the claims.
- Track the status of appeals by monitoring the appeal bucket and performing regular follow-ups until the appeal is resolved.
Coding and Compliance:
- Assist with coding issues by reviewing and suggesting appropriate corrections to ensure accurate billing and compliance with medical coding standards.
Communication and Customer Service:
- Respond to patient inquiries, providing clear explanations of benefits and answering insurance-related questions.
- Ensure timely and professional responses to emails and voicemails related to billing inquiries.
Surgical and Commercial Billing:
- Handle billing for surgical procedures, ensuring accuracy and completeness of all claims.
- Manage commercial billing processes, including claim submission and follow-up.
Cross-Training and Collaboration:
- Be cross-trained and serve as a backup for various billing positions within the department, maintaining the flexibility to support different functions as needed.
Administrative Support:
- Complete actions and telephone encounters promptly, maintaining a high standard of patient service.
- Participate in special projects and perform additional duties as assigned by supervisors or management to support the billing department.
Qualifications:
- Associate or bachelor’s degree in finance, accounting, healthcare administration, or a related field is preferred.
- Certification in medical billing and coding is highly desirable.
- Minimum of 2 years of experience in medical billing, specifically in an orthopedic or similar specialty practice.
- Proficiency with medical billing software, preferably ECW (eClinicalWorks), and a solid understanding of EFTs.
- Knowledge of medical terminology, ICD-10, and CPT coding.
- Strong analytical skills and attention to detail.
- Excellent communication and customer service skills, with the ability to explain complex billing issues in understandable terms.
- Ability to manage multiple tasks and prioritize work to adhere to deadlines and patient service standards.
The Medical Billing Specialist at Chicago Center for Sports Medicine & Orthopedic Surgery is integral to our team, ensuring the practice's financial health through meticulous billing management and exceptional patient service. If you have a passion for healthcare finance and a commitment to excellence, we invite you to apply.