Medical Billing Specialist

Summary of Position

To manage the accounts receivable for timely and maximum reimbursement by adhering to company billing, posting and collection documented policies and procedures.

Nature and Scope

The Medical Billing Specialist is responsible for accurate and timely processing of all third-party billing (claims) and self-pay billing; performs all routine follow-up until collection or final disposition of the account balance. Interacts routinely with physicians, managers, and office staff to maintain a continuous flow of charge and insurance processing for timely and appropriate reimbursement. Responsibilities include all Professional Billing system documentation, adjustments, accurate demographic and insurance coverage entry verifying eligibility when available. Medical Billing Specialists are required to verify insurance eligibility before accepting new or corrected charges.

Principle Duties and Responsibilities

1. Responsible for the accurate and timely filing of all third-party claims on behalf of patients/guarantors.

2. Coordinates primary and secondary third-party coverage and bills in accordance with regulations.

3. Ensures revenue (charges, payments, and adjustments) is recognized, billed, collected, posted, and followed-up on accurately and in a timely manner to maximize collections.

4. Verifies electronic eligibility before submitting charges, when applicable, on claims to promote clean claims submission.

5. Performs all routine and special follow-up on all assigned accounts using telephone and appropriate correspondence to enhance effective collection of the account balance; negotiates payment terms for payment plans, coordinates collection activities between patients and third parties.

6. Follows all documented policies.

7. Uses appropriate write off codes.

8. Documents all activity on accounts, including corrections, collection activities using detailed notes including dates, reference numbers, next actions to be taken, and next follow up steps.

9. Receives, respond and clearly documents all incoming account inquiries, both telephone and correspondence.

10. Implements the standards for DOCS, including the Customer Service and Teamwork standards.

11. Handles clearinghouse edits and rejections

12. Other duties as assigned.

Qualifications

Education & Experience

· High School diploma or equivalent certificate

· Knowledgeable about third party billing regulations and CPT/HCPCS and ICD10 coding

· Data entry skills

· Proven record of dependability

· Experience with electronic patient account billing systems preferred

· Minimum of 4 years physician/lab billing and collections experience.

· Anthem AR experience is a plus

Knowledge, Skills, and Abilities

· Strong people, communication and decision-making skills

· Must be self-motivated and be able to work independently and proactively. Able to handle and prioritize numerous and varied requests and tasks and reprioritize as needed.

· Able to handle ambiguity and remain flexible. Respond constructively to the demands of work schedule when confronted with change. Must be proactive instead of reactive.

· Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physician, co-workers and employees.

· Must have a positive attitude and enjoy working as part of a team.