Billing Specialist

Job Description

JOB SUMMARY

The Billing Specialist is responsible for the accurate and timely submission, follow-up, and resolution of medical claims. This position requires in-depth knowledge of procedural coding, ICD-10, CPT, HCPCS, CMS-1500 claim forms, electronic claims submission, payment posting, denials, and appeals. We are seeking a candidate with infusion billing experience, including biologic and specialty medication billing, to support our growing infusion services.

QUALIFICATIONS/EDUCATION

High School Diploma required. Minimum 2 years of experience in medical billing and collections. Previous infusion billing experience required, including biologic and specialty medication billing. Experience with infusion claims, medication billing, J-codes, and payer reimbursement preferred. Bilingual English/Spanish preferred; must be able to read, write, and speak English. Basic computer knowledge, including Microsoft Word, Excel, Internet, Electronic Health Records (EHR), practice management systems, e-faxes, and email.

CERTIFICATIONS/LICENSES

CPC preferred.

ABILITIES/SKILLS

In-depth knowledge of CPT, ICD-10, HCPCS, and medical billing regulations. Knowledge of infusion billing, biologic medications, J-code billing, and payer reimbursement guidelines. Understanding of Medicare, Medicaid, and commercial payer billing requirements. Excellent communication, customer service, and telephone skills. Strong organizational skills and ability to multi-task effectively. Must be able to work independently with minimal supervision. Ability to respect and maintain patient confidentiality at all times. Dependable, professional, and detail-oriented. Demonstrates proficiency in the use of personal computers, Electronic Health Records, billing software, and Microsoft Office applications. Must be able to follow company policies and procedures.

SUPERVISORY RESPONSIBILITIES

N/A

ESSENTIAL DUTIES/RESPONSIBILITIES

Process medical claims daily, ensuring the correct diagnosis, CPT, HCPCS, and infusion-related billing codes are utilized. Submit infusion and specialty medication claims accurately and in accordance with payer guidelines. Review claims to determine whether prior authorizations or referrals are required and ensure all necessary documentation is complete. Maintain the billing process within the established 15-day billing timeframe. Process between 80 and 100 claims per day while maintaining accuracy and productivity standards. Submit claim batches to the clearinghouse daily. Review and resolve claim rejections and denials, resubmitting corrected claims as appropriate. Follow up with insurance carriers regarding unpaid, denied, or underpaid infusion and medical claims. Review provider documentation and progress notes to ensure accurate billing and coding. Analyze denial trends and identify opportunities to improve reimbursement and reduce billing errors. Maintain accurate and detailed account notes within the billing system. Prepare and submit weekly productivity reports to the Revenue Cycle Manager. Collaborate with providers, coding staff, authorization staff, and infusion personnel to resolve billing issues and maximize reimbursement. Perform other duties as assigned by management. We offer a competitive salary; Employee Health Insurance is covered at 100% We also offer Dental, Vision, Life, and 401k Benefits. #J-18808-Ljbffr Gastromed, LLC