Medical Billing Specialist

Position Title: Medical Billing Specialist
Department: RCM Billing
Position Summary: (Overall purpose of this position)

• Able to fit the Telework Agreement requirements for remote employees which will require monthly on-site mandatory all staff meetings and rotational monthly billing workflows in Cleveland, Ohio.
• Responsible for all medical, behavioral health and dental billing activities to include posting charges, payments and adjustments to patient accounts.
• Clear understanding and interpretation of an Explanation of Benefits and how that is applied to a patients billing account.
• Responsible for timely collection of amounts due from patients and insurance carriers.
• Liaison between Neighborhood Family Practice and patients/insurance carriers regarding billing issues and inquiries.

Essential duties and responsibilities which must be performed in order to carry out the position purpose summarized above: The following description is a general representation of the key duties and responsibilities of this position. Other duties may be assigned, as required.

1. Review, and submit insurance carrier claims (1500 & UB04) on a regular daily schedule to insurance carriers to ensure prompt processing and payment. In tandem with FQHC, HRSA, CPT, CPTII and ICD10 Payment Guidelines.
2. Follow-up on unpaid or outstanding patient and insurance balances to resolve any billing issues. This process includes timely review of EPIC PB Workqueues, as assigned by the Billing Supervisor.
3. Work in collaboration with billing team mates on incoming phone calls while addressing patient questions and escalating concerns to the Billing Supervisor.
4. Understanding the importance of posting charges, payments and adjustments in a timely manner.
5. Ensure appropriate application of CPT, CPTII and ICD10 codes. Identify coding inefficiencies to communicate to the provider for resolution and clean claims.
6. Review accounts for possible assignment to collection agency and make recommendations to the Billing Supervisor.
7. Maintain information in a confidential manner.
8. Identify and resolve patient and insurance refund workflows.
9. Participate in educational activities hosted onsite in Cleveland, Ohio and virtually by OCHIN EPIC is required.
10. Able to work remotely with limited onsite requirements.

Qualifications: Specific knowledge, training or skills required to perform the duties of this position. Specific concepts, courses, training programs or required certifications:

• Familiarity with governmental (Medicare and Medicaid) and health care fiscal regulations, billing and reporting.
• Possess strong communication skills in an organized manner.
• Possess strong analytical and problem solving skills.
• Possess strong math skills.
• Fluency in English and Spanish is beneficial to the role.
• Computer proficiency: related EPIC PB software and Microsoft Office Suite to include TEAMS Meeting.
• High school diploma or GED.

Essential Physical Demands and Working Environment:
The physical demands and work environment described below are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to see, communicate, hear and utilize electronic communication devices.
• HIPAA compliant HOME / REMOTE office work environment, not shared with others is required.
• Limited local (Cleveland, OH) travel is required.
• Previous experience that is necessary background to qualify for this position: Minimum of 2 years in medical / physician billing experience with specific knowledge in medical terminology and CPT, CPTII and ICD10 concepts.

REPORTS TO AND EVALUATED BY: Billing Department Supervisor