Medical Billing Specialist

• The medical biller is responsible for the timely submission of professional medical claims to various payors.
• Prepare, review, and transmit claims for electronic and/or paper claim submission from the PM system.
• Responsible for resolving claim edits and clearinghouse rejections via the PM system.
• Responsible for processing all secondary claims via electronic and/or paper claim submission.
• Responsible for submitting claims with required documents, per payor guidelines or as requested (i.e., medical records).
• Review patient statements for accuracy and completeness prior to billing.
• Maintain a current understanding of local coverage determinations, payor and coding guidelines to ensure claims are consistently billed properly.
• Perform charge reconciliation from the daily appointment schedule.
• Perform posting of charges, electronic and/or manual to the PM system.
• Keep abreast with medical coding updates and educate team members of changes in a timely manner.
• The specialist will maintain confidentiality and is knowledgeable of AMA CPT, HCPCS, and ICD codes and HIPPA guidelines.
• Ensure patient and insurance demographics are accurate.
• Enter and make the appropriate changes in the EMR/PM system(s) regarding insurance and eligibility, and insurance information, as needed.
• Respond to email and phone calls related to billing and claim submissions.
• Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
• Ensure appropriate authorization or referral numbers are on the claim prior to submission.
• Performs job duties with oversight.
• Other duties as assigned.

Qualifications:

• High School diploma or equivalent required
• 3 years of experience in medical billing strongly preferred
• 3 years of experience in a specialty group practice preferred
• Comfortable navigating across various computer systems to locate critical information.
• Medical billing and coding certification preferred.
• Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
• Experience with a CMS-1500 claim form.
• Experience working with clearinghouses for the purpose of claim submissions.

Job Type: Full-time

Pay: $26.00 - $28.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $26 - $28