Medical Billing Specialist

Job Description Billing & Invoicing work is focused on designing and ensuring compliance with billing and invoicing processes including: Information verification (e.g., ensure accuracy of billing information, negotiated terms and compliance with current legislation) Monitoring customer accounts (e.g., ensure payments made on time, report on overdue accounts, etc.) Resolving billing discrepancies (e.g., investigate and resolve billing & invoicing errors, recommend process improvements to avoid future errors, etc.) May include collections activities Requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. May require the following proficiency: Works under moderate supervision. Problems are typically of a routine nature but may at times require interpretation or deviation from standard procedures. Communicates information that requires some explanation or interpretation. Key Responsibilities Responsible for claim review and submission to Medicare, Medicaid, commercial and private insurance payers. Verifies accuracy and completeness of all required information prior to submission. Follows up with insurance companies on unpaid or rejected claims. Resolves issues and resubmits claims. Reads and interprets insurance explanation of benefits. Maintains specialized knowledge in insurance processes and guidelines, including authorizations and limitations. Investigates insurance claim denials, exceptions, or exclusions. Takes necessary action to resolve claim and payer issues in an effort to recover proper reimbursement. Provides customer service relating to all billing inquiries and complaints. Able to explain insurance processes, benefits, and exclusions. Follows HIPAA guidelines in handling customer information. Performs other billing duties as requested by the Billing Supervisor, Billing Manager, or Director of Billing. Qualifications/Education Must have a high school diploma, college degree preferred, not required. Six months to one year of related experience and/or training; or equivalent combination of education and experience. Proficient in use of computers and software including, but not limited to: practice management software, word processing and spreadsheet applications. Detail oriented with ability to multi-task. Manages one’s own time with minimal supervision. Strong mathematics and problem-solving skills. Seeks and shares pertinent information related to insurance or internal processes. Communicates effectively both verbally and in writing to convey and receive information. Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. Self-evaluates performance to make improvements or take corrective action. Consider the relative costs and benefits of potential actions to choose the most appropriate one. Use equipment, facilities, and materials appropriately as needed to do certain work. This position must commit to 9 months in the role before applying for alternative roles within the organization. Exceptions must be approved by Department leadership. Physical Demands Regularly required to sit, stand, walk, and occasionally bend and move about the facility. Infrequent light physical effort required. Occasional lifting under 10 lbs. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Working Conditions Work performed in an office environment. Seniority Level Not Applicable Employment Type Full-time Job Function Accounting/Auditing Industries Medical Equipment Manufacturing #J-18808-Ljbffr