Medical Billing Specialist (Remote)

Medical Billing Specialist

The Medical Billing Specialist (EBO Specialist) will review and analyze accounts to determine correct reimbursement, processing and billing claims, review and resolve credit balances, interface with third party payors, patients, and clients. A dedicated home office space must be available with high-speed internet and peripheral equipment. Candidate will execute JTS’ Remote Staff Agreement to ensure Security and Privacy.

This position requires expert knowledge of revenue cycle processes and systems and proficiency in creating standard work procedures, problem solving, and making process improvement recommendations.

The EBO Specialist works collaboratively with internal team members and client liaison and contributes to a positive working environment and team spirit. ALL answers to our questions must be completed in full in order for the application to be considered valid.

Primary Responsibilities:

• Works with various revenue cycle applications using time management skills to meet productivity and quality measures.
• Works within payer portals, such as Availity, Navinet, Optum Link, MMIS and Medicare Contractors
• Understands payor contracts and can apply calculations to resolve under/overpayments
• Knowledge of medical terminology such as CPT, HCPCS, APC, ASC, DRG and ICD10
• Understands electronic remittance advices (835) and explanation of benefits; Applies knowledge toward account resolution
• Submits reconsiderations and appeals related to denials using payor documentation and portals
• Interacts with third party payors, patients and clients to resolve account balances
• Processes Initial and corrected claims billing
• Reviews, researches and resolves claim rejections and credit balances
• Uses and creates standard work processes in daily work activities
• Performs other duties as assigned

Required Qualifications:

• Minimum of 5 years' experience in revenue cycle processes within a hospital (in patient) setting, including registration, billing, insurance follow up, denials management, payment variances, cash applications, credit balance resolution, posting, and audit
• Proficient to expert level knowledge of Cerner Community Works
• Preferred knowledge of CPSI and Rural Health experience
• Working knowledge and interpretation of payor contracts, federal and state regulations, and payor appeal processes
• Demonstrate experience with reviewing and resolving claims with Medicare, Medicare eligibility, etc, commercial payors, etc.
• Exceptional time management and organizational skills, ability to direct work with minimal supervision
• Exceptional verbal and written communication skills
• Analytical and problem-solving skills
• High school diploma or GED required

Preferred Qualifications:

• Associates or Bachelor’s degree, a plus
• HFMA Certified Patient Accounts Representative (CPAR or ACPAR)
• Certified Revenue Cycle Representative (CRCR)

JTS Health Partners (JTS) is a healthcare professional services and analytics firm focused on Revenue Cycle Management (RCM), Health Information Management (HIM), Health Information Technology (HIT), Healthcare Analytics as a Service (AaaS) and Financial Technology (FinTech). JTS offers consulting, operational and analytical services that align with performance improvement initiatives of healthcare systems, hospitals and physician practices. At JTS, we create the “WOW” factor for each other and our clients. We embrace a culture where employees are empowered to be innovative and grow personally and professionally.

JTS is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race; color; religion; national origin; sex; pregnancy; sexual orientation; gender identity and/or expression; age; disability; genetic information, citizenship status; military service obligations or any other category protected by applicable federal, state, or local law. JTS makes hiring decisions based solely on qualifications, merit, business needs.

JTS is a drug-free workplace and does conduct pre-employment drug testing.