Billing & Collections Specialist

The medical billing and collection specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and collection specialist must possess critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments base on payer contracts or government regulations. In addition, the medical billing and collection specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims to Insurances nationwide.

Accountabilities:

• Responsible for charge andpaymententry within Electronic Health Record. Coordinates and clarifies with clients/customers, when necessary, on information that seems incomplete or is lacking for proper account / claim adjudication.
• Responsible for correcting, completing, and processing claims for all payer codes.
• Analyze and interpret theclaimsareaccurately sent to insurance companies.
• Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and health insurance companies on unpaid insurance accountsidentifiedthrough aging reports.
• Able toidentifyand appeal claims if needed and or ability to process appeals online or via paper submission; Assist with billing audit related information.
• Attends customer meetings/ workshops / implementations when needed.
• Ability to navigate commercial/customer payment platformsand orportals.
• Communicate daily with internal and external customers via phone calls and written communications.
• Identifytrends,and carrier issues relating to billing and reimbursements. Report findings to Team Lead and/or Supervisor.
• Research, record findings, and communicate effectively with Manager to achieveoptimumperformance.
• Pursue andparticipatein education to remain current with changes in the Healthcare industry.
• Maintain HIPPA/PHI requirements.
• Promote effective working relations and work effectively as part of a team tofacilitatethe department's ability to meet its goals andobjectives.
• Demonstrate respecttoall fellow employees to ensure a professional,responsibleand courteous environment.
• Other duties andprojects asassigned by management.

Requirements:

• Minimum of one year of related experience in clinical, medical, or medical servicesenvironment.

• Previousexperience in a medical office setting and/or experience with an Electronic MedicalRecorda plus.
• Customer servicedriven.
• Understanding of medical terminology and insurance laws/guidelines
• Excellent organization and time management skills along with excellent oral and written communication skills.
• Strong teamplayer.
• Ability to learn quickly, build andmaintainlong termrelationshipsand work with minimal supervision.
• Strong written and verbal communication skills; strong analytical, organizational and time management skillsrequired. The ideal candidate will have billing software experience or have used similar billing systems.

Language Skills:


Ability to read, analyze, and interpret general health and social services guidelines, technical procedures or governmental regulations. Ability to write reports, health correspondence and procedure manuals. Ability to effectively present information and respond to questions from groups or patients, center staff, and the general public.

Mathematical Skills:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions.

Customer Relationships:

Follow through with customer inquiries, requests and complaints. Forward difficult and non-routine inquiries or requests to appropriate level for resolution.

Work Environment:

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is largely a desk-bound role with typical office noise; however, frequent movement throughout the office is required. Frequent sitting, standing, and walking are daily activities. Some bending and filing may be required (<10% of time). This would require the ability to lift files (<10 lbs.), open filing cabinets and bend or stand as necessary. Over 2/3 of Time: See; Sit; Use hands to finger/handle/feel; Talk or Hear.

Position Type:

This is a full-time, non-exempt-level position based at Corporate headquarters.