Job Description

Job Description

Job Description

Overview of the Position:

Responsible for correctly processing healthcare claims in order to obtain reimbursement from insurance companies and government healthcare programs, such as Medicare and Medicaid.

Education and Experience:

• High School Diploma or GED required. Associates degree in related field preferred

• 1-2 years of medical billing and follow-up experience desired

• CPC and/or CPB or similar certification highly desired but not required

• eClinicalWorks experience preferred

• Proficient with Microsoft Office Suite specifically Excel, Word, and Power Point

• Advance and current working knowledge of ICD-10, CPT, and HCPCS codes

• Current knowledge of insurance payer coding and reimbursement guidelines

Required Skills / Abilities:

• Demonstrates the ability to work in a high pressure environment

• Strong active listening skills, attention to detail, and decision-making skills are required

• Pleasant, friendly attitude with the ability to adapt to change is essential

• Superior problem- solving abilities is required

• Ability to collaborate with all departments

• Possess the ability to work with patients, clinical, non-clinical staff and providers from a variety of backgrounds and lifestyles while maintaining a non-judgmental attitude.

• Possess excellent customer service skills and be well organized.

• Ability to communicate effectively utilizing both oral and written means.

• Ability to handle various tasks simultaneously while working efficiently, effectively, and independently

• Must be comfortable taking direction from Leadership

Supervisory Responsibilities:

• No supervisory responsibilities

Essential Job Functions:

These essential job functions are required of the Billing Specialist based upon departmental and organizational guidelines, processes, and/or policies. It is the Billing Specialists responsibility while working to ensure excellence in service for the internal and external customers.

• Validates the accuracy of claim information so that future billing and follow up activities are conducted effectively and to assure a high degree of customer service.

• Apply approved adjustments to accounts per departmental and company policy.

• Scrub claims for errors. Mark all appropriate corrections per departmental and payer guidelines.

• File all electronic claims and hard copy claims daily.

• Processes daily all mail and direct correspondence related to open accounts to secure payment, including rejections, denials, or requests for re-bills. Identifies accounts that need rebilling and performs this task within two (2) business days.

• Provides assistance to other department staff with questions or problems related to patient payments, adjustments, remittance advises, or other correspondence in a timely manner

• Receives incoming calls from patients and/or insurance companies. Answer questions and provide information in a courteous and cooperative manner. Returns phone calls within 24 hours.

• Address all actions within 48 hours. Urgent actions are addressed in 24 hours.

• Responsible for maintaining daily account and follow-up worklists within department while maintaining organization’s productivity standard. Work account receivables by addressing claims that qualify for insurance follow-up by working claim status buckets. Contact insurance companies within payer specific follow-up guidelines and secures appropriate information about each claim. Document the account as to what is happening on each claim for future reference.

• Adhere to all departmental and organizational guidelines, processes, and policies.

• Attends and participates in departmental and organizational meetings and continuing education opportunities

• Demonstrates and promotes a positive patient/customer service attitude

• Perform other duties as assigned

Physical Requirements:

Must possess the ability to communicate in the dominant language of the geographic region. Must be able to lift 30 pounds. Vision and hearing corrected to within normal limits is required. Must have manual dexterity to key in data; utilize computer, grab, grip, hold, tear, cut, sort, and reach.

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