INSURANCE BILLING SPECIALIST

Job Title

Essential Functions and Basic Duties

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

• N/A

Position-Specific Performance Expectations, Duties, and Responsibilities:

• Processes and submits health insurance claims to various insurance companies in a timely and accurate manner.
• Ensures claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS). Collaborates with the coding and clinical departments to resolve edits and denials.
• Maintains a working knowledge of Medicare and Medicaid as well as commercial payer guidelines and stays abreast of new policy changes.
• Verifies patient eligibility and coverage details before claim submission and reconciles coverage denials when necessary.
• Resolves claim edits both in the electronic medical record (EMR) and in the clearinghouse to prevent denials.
• Follows up with insurance companies regarding denied or underpaid claims and submits appeals when appropriate.
• Reviews insurance and patient credit balances and resolves them in a timely manner.
• Educates patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities.
• Documents all actions taken with an account in the electronic medical record (EMR).
• Performs other duties as assigned.

Organization-Specific Performance Expectations, Duties, and Responsibilities:

• Demonstrates full commitment to the CHOICE values of MRH and consistently represents the organization in a positive, professional manner.
• Establishes and maintains effective verbal and written communication, fostering positive working relationships with patients, staff, and vendors.
• Adheres to the MRH attire and dress code in accordance with organizational policies and procedures.
• Exhibits initiative and self-motivation; maintains a consistent level of productivity and manages time and responsibilities effectively.
• Completes all required annual education, training, in-services, and licensure/certification updates; actively participates in departmental and organizational meetings or reviews meeting minutes as required.
• Maintains strict patient confidentiality at all times.
• Reports to work punctually and completes assigned duties within established timeframes.
• Actively contributes to departmental and organization-wide performance improvement and continuous quality initiatives.
• Ensures compliance with all regulatory requirements, maintaining adherence to departmental, hospital, state, and federal standards and policies.
• Follows all infection control, safety, and risk management procedures to maintain a safe environment for patients, the public, and staff.

Qualifications:

• Must be at least 18 years of age (21 for positions requiring driving, with a valid driver's license).
• Must be legally authorized to work in the United States.
• Must successfully pass a background check.
• Must successfully pass a pre-employment drug screen and breath alcohol test (if applicable).
• Must complete an Employee Health meeting prior to starting employment.

Experience

Required: Two (2) years prior experience in medical billing, accounts receivable, or related field. (Can substitute with a medical billing or coding certification (CPC, CPB, RHIT, CCS, etc.)

Preferred: Prior authorization experience. Epic or similar EMR experience. Knowledge of UB-04 and CMS-1500 claims forms.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.