Medical Billing Specialist

Title: Medical Billing Specialist

Job Summary:

Our Client is looking for a Medical Billing Specialist. The Medical Billing Specialist in a pharmacy plays a crucial role in ensuring the accurate and timely collection of payments from insurance companies, patients, and other third-party payers. This position requires strong attention to detail, excellent communication skills, and a solid understanding of insurance billing processes and regulations. The primary responsibility of a Medical Billing Specialist is to maximize revenue by minimizing outstanding balances and resolving billing discrepancies.

Duties and Responsibilities:

1. Billing and Claims Processing:

• Generate and submit accurate insurance claims to various payers, including private insurance companies, Medicare, and Medicaid.
• Verify patient insurance coverage, benefits, and eligibility.
• Review claims for accuracy, completeness, and compliance with insurance requirements and pharmacy policies.
• Resolve claim rejections, denials, and other billing errors.
• Follow up with insurance companies to ensure prompt payment of outstanding claims.

2. Collections and Payment Posting:

• Monitor and manage outstanding accounts receivable.
• Contact patients, insurance companies, and other third-party payers to collect overdue payments.
• Negotiate payment arrangements and develop repayment plans, when necessary.
• Post payments accurately to patient accounts and reconcile discrepancies.
• Investigate and resolve billing discrepancies and disputes.

3. Customer Service:

• Provide excellent customer service to patients, healthcare providers, and insurance representatives.
• Demonstrate calm communication during challenging calls for positive interactions.
• Respond to inquiries regarding billing and insurance claims status.
• Address patient concerns and assist in resolving billing-related issues.
• Efficiently track and follow up on calls with a professional and systematic approach.

4. Compliance and Documentation:

• Maintain patient confidentiality and adhere to HIPAA regulations.
• Ensure compliance with federal and state laws and regulations related to billing and collections.
• Document all communication and activities related to billing and collections accurately and thoroughly.

5. Financial Reporting:

• Prepare and analyze reports related to accounts receivable, collections, and aging of outstanding balances.
• Identify trends and areas for improvement in billing and collections processes.
• Provide regular updates and reports to the pharmacy management team.

Qualifications and Skills:

• High school diploma or equivalent (some employers may require an associate's or bachelor's degree).
• Previous experience in medical or pharmacy billing, collections, or healthcare finance preferred.
• Knowledge of insurance billing processes, reimbursement policies, and medical coding systems (e.g., CPT, ICD-10).
• Familiarity with pharmacy claims processing software and electronic health records (EHR) systems.
• Strong understanding of insurance regulations, including Medicare and Medicaid guidelines.
• Excellent communication and interpersonal skills for effective interaction with patients, healthcare providers, and insurance representatives.
• Attention to detail and accuracy in data entry, record-keeping, and financial reporting.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Proficiency in using office software (e.g., Microsoft Excel, Word) and billing software applications.

Note: This job description is a general overview of the typical duties and responsibilities of a Medical Billing Specialist in a pharmacy setting. The specific job requirements and responsibilities may vary depending on the organization, size of the pharmacy, and regional regulations.
Location: Bardonia, NY
Salary: $50,000 - $55,000 DOE