Medical Billing Specialist

Job Description

Job Description

The Medical Billing Specialist is responsible for the billing and collection of office visits, procedures, nurse procedures, and all other billing events as a result of practice activities. Additional responsibilities include keeping up to date with coding and billing regulations as well as maintaining an understanding and compliance with all Skin Wellness Physicians policies and procedures.

Essential Duties and Responsibilities
As assigned, but not limited to the following:

• Develops and implements, with the Practice Administrator, procedures for all aspects of the billing process including charge entry, day end balancing, claims submission and edit, insurance follow up, patient balance follow up, denials, transfers to patient balance, cash collection, collection accounts, adjustments and write-offs.
• Audits daily charges and payments for all practice locations and initiates corrective actions where required.
• Assists with coding and billing error resolution for all practice locations.
• Submit claims electronically and by paper as requested.
• Monitors patient balances/coordinates practice action with billing staff and front desk personnel.
• Monitors practice schedules for self-pay visits and insurance entry discrepancies and initiate corrective actions where required.
• Coordinates collection efforts with outside payers to optimize collection efficiency.
• Maximizes payments in accordance with the policies of the practice.
• Reviews all patient and third-party payer refund requests for accuracy. If appropriate, remits refund payments as applicable.
• Review and work insurance aging reports. Call for payment and review for in house collections when necessary.
• Assists with submitting necessary documentation to collection agency and ensures proper collections notifications are sent to applicable patients in a timely manner.
• Knowledge and understanding of Explanation of Benefits (EOB) from insurance carriers
• Ensures compliance with insurance contract terms. Set up patient statement billing and respond with any questions or requests.
• Maintains current knowledge of payer requirements, Medicare regulations, CPT coding and ICD codes and performs regular payment analysis to evaluate charges and coding.
• Educates front desk personnel regarding insurance and coding questions. 
• Respond to interoffice messages and take necessary actions where required.
• Follow up via phone, email or patient web portals to obtain payment and or denial reasons
• Ensures compliance with all HIPAA requirements and other relevant medical office regulations.
• Posts payments from assigned insurance companies, patient payments, and lockbox
• Identifies errors in payments, corrects errors and resubmits for corrected payment.
• Researches, corrects and resubmits denials.
• Appeals denials when necessary.
• Sends information, upon request, to appropriate insurance company and/or patient.
• Answers phone calls from patients and staff with questions regarding billing/accounts.
• Assist with insurance verification and prior authorizations when needed
• Review daily batch for all practice locations and initiates corrective actions where required
• Reconcile daily deposit slips with bank as requested
• Perform daily deposits as requested
• Retrieve and post ACH payments from clearing house 
• Utilizes EMR and other relevant software where required
• Allocate payments as necessary
• Attends staff meetings where required
• Performs related work as required.