Medical Billing Specialist

Responsibilities Generate primary and secondary paper bills according to established procedures. Edit paper claims before mailing. Perform claim follow‑up on denials quickly and accurately from assigned payers to ensure revenues are received in a timely manner. Run 837 files according to established procedures and resolve any validation issues. Accurately and timely enter data into payer websites for original claim submissions and/or corrected claims submissions. Verify and post remittance from assigned payers. Re‑bill accounts as necessary to ensure an open insurance receivable against which a payment can be applied. Thoroughly research questionable/unidentified payments in order to post properly or refund to payer per payer guidelines. Work with payers and subscribers to resolve issues and facilitate prompt payment of claims. Verify NAP issues and work to resolve them. Identify and communicate to up‑line delays affecting balancing issues, new codes, or adjustments. Identify and communicate to up‑line any Psych Consult issues such as fee matrix, CPT codes, units or rates to eliminate inefficiencies and/or obstacles in billing process. Reconcile funds in the bank to payments posted. Prepare adjustments such as refunds, contractual differences and write‑offs for approval and processing. Work open/billed reports and/or aged reports timely to ensure revenue is not lost. Monitor payer websites for benefit information and requirements; communicate timely to manager if our system needs updating for accurate billing. Follow up on corrected claims to ensure filing time guidelines are met. Receive incoming telephone and email inquiries from patients, families, internal staff and insurance companies and resolve/refer appropriately. Document detailed notes in the Psych Consult Patient Accounts Screen efficiently and accurately, reviewing notes documented by others before proceeding on issues. Forward all authorization issues/concerns to the Managed Care Coordinator timely to ensure revenue is not lost and document in the system. Communicate appropriately utilizing a service account. Support co‑workers toward completion of assigned projects/tasks. Backup for clerical staff at Behavioral Health facilities as needed. Suggest new workflows and/or office procedures to increase customer satisfaction and/or staff productivity. Scan, OCR, and redact in scanning software. Qualifications High school diploma or equivalent is required; an associate degree in an accounting field is preferred. Minimum of four years experience in an accounts receivable environment with at least three years specific to health care billing, including cash posting, submitting paper and electronic claims, and working rejections/denials. Knowledge of insurance reimbursement guidelines for Medical Assistance, Commercial Plans, Medicare and Medicare HMO plans is required. Knowledge of Allegheny County guidelines is preferred. Proficiency with personal computer base applications and other office equipment. Good oral and written communication skills are required. Ability to convey an outstanding first contact experience to all customers, including internal and external contacts. Ability to perform multiple tasks and exhibit strong task analysis and completion skills. Excellent organizational, time‑management, and follow‑up skills. Maintains confidentiality with regard to all job assignments. Apply online at #J-18808-Ljbffr