General summaries of duties: Under the general supervision of the Manager of Revenue Cycle Management the Medical Billing Specialist is responsible for accurate claims submission, accounts receivable follow-up, payment posting, EOB and COB processing, credit balance refunds, bad debt and collections. Research problems and determines correct action steps to resolve eligibility, billing and account problems working in collaboration with patients, coding team and insurance companies. Analyzes data and provides feedback and recommendations to management related to findings.

Essential Responsibilities:

• Patient eligibility: Applies eligibility process to respond to patient/staff inquiries regarding eligibility for services at MVMG.
• Patient coverage and COB: Maintains current knowledge of major payer provisions and regulations including Medicaid, Medicare, and BCBS; understands and applies the concepts of primary and secondary coverage; uses available electronic resources to determine coverage; works directly with patients and insurance carriers to resolve questions of coverage; works with staff to ensure that insurance coverage is properly documented and shared throughout the organization.
• Charge Scrubbing: Reviews hold queues for claims that have failed the rules for clean claim submission and corrects errors as appropriate within filing limit restrictions.
• Charge Process Troubleshooting: Identifies problems related to the posting of charges or payments in the clinical system (e.g., providers consistently late in submitting charges, problems associated with payment posting at time of service, inappropriate coding of services) and notifies the coder, Lead Coder or Manager of Revenue Cycle Management as appropriate; identifies system enhancements (e.g., modifier always required, reports to facilitate finding a specific set of services) to facilitate the billing process.
• Claims Adjudication (payment and adjustment posting): Understands how to read an EOB; applies knowledge of claims adjudication to determining what to do with balance after insurance, patient responsibility, and when to use contractual and other adjustment types; resolves overpayments on accounts.
• Denials and Appeals: Determines the causes for denials; works timely on corrective actions to appeal denials; alerts the coder to systematic coding problems causing denials.
• Collections: assists patients to understand the collections process; understands the process for writing off bad debt and recalling accounts from collections.
• Customer Service: Interacts with patients in person, by phone, mail, or by secure email to address insurance coverage, payment obligation, or other needs for medical financial information; keeps the patient informed of the status of their inquiry if problem will take longer than a day to resolve; listens carefully to each patient concern to ensure that the concern is addressed.
• Adheres to the expectations and professional responsibilities of the department.
• Employs the standards, practices, and procedures of the department.
• Completes and complies with MVMG training requirements including HIPAA Privacy and Security.
• Reports non-compliance incidents to the supervisor, manager, and/or Compliance Officer.

Typical physical demands:

· Work may require sitting for long periods of time, stooping, bending, and stretching for files and supplies, and occasionally lifting files or paper weighing up to 30 pounds.

· Ability to sufficiently operate a keyboard, calculator, telephone, copier, and such other office equipment as necessary.

· Must be able to record, prepare, and communicate appropriate reports in a verbal and written format.

· It is necessary to view and type on computer screens for long periods and to work in an environment which can be very stressful.

Job Qualifications:

· High School graduate or equivalent.

· At least three years’ medical billing experience.

· Must have a working knowledge of CPT and ICD-10 codes, data entry systems for 3rd party billing, various types of payers and their reimbursement and denial patterns.

· Thorough understanding of medical terminology.

· Prior working experience with Medicaid, Blue Cross/Blue Shield, Medicare and other Commercial billing systems preferred.

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• No weekends

Work setting:

• Office

Ability to Relocate:

• Colorado Springs, CO 80920: Relocate before starting work (Required)

Work Location: In person