Medical Billing Specialist I

Medical Billing Specialist The Medical Billing Specialist processes hospital claims for reimbursement. Responsibilities may include data entry, reconciling billings, checking balances, filing appeals, and maintaining patient files. Works with insurance companies to perform insurance billing, review, and verification of accounts in accordance with program provisions. Monday Friday 8:00 AM 4:30 PM Reporting Structure: Reports to the Revenue Cycle Manager Minimum Qualification Requirements Education:High School diploma or GED Equivalent required. Some college business training. Work Experience:Must have six months to one (1) year general office experience. Medical hospital billing experience preferred. License/Certification:N/ACore CompetenciesMission, VisionCore Value/Standards of ConductAIDET/Organizational ExpectationsSafetyQualityFlexibilityCustomer ServiceDiversity and InclusionFinanceAbuse and Neglect of Adult PatientAbuse and Neglect of Pediatric PatientAcute Coronary Syndrome/Chest Pain ProtocolsBiohazard WasteCC Hand HygieneJob Specific Core CompetenciesSkills, Knowledge, Abilities, BehaviorMedical TerminologyMedicare, Medicaid, and other third party billing concepts, fee for serviceProblem ResolutionPatient Billing SystemsElectronic Billing SystemsCPT, Payer coding conceptsOrganization ExpectationsDemonstration of Core Values:Integrity, Compassion, Teamwork, Trust, Innovation, Stewardship, Excellence, and Respect.Provides a positive and professional representation of the organization.Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience.Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.Participates in ongoing quality improvement activities.Maintains compliance with organization's policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.Complies with organizational and regulatory policies for handling confidential patient information.Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and regulatory agency and accrediting standards (TJC, DNV, etc.). Understands this position is an onsite, full-time position. Hours and days as follow:Monday-Friday 8:00 AM 4:30 PM Essential Functions Prepares and submits corrected claims to various insurance companies either electronically or by paper. Performs all processes necessary for follow-up on claims for insurance payment including but not limited to calling insurance companies, calling patients if needed, filing appeals. Maintaining records of medical billing and claims, settlements, and medical insurance. Answers questions from patients, clerical staff, and insurance companies. Identifies and resolves patient billing complaints. Communicate with coding department to be sure that corresponding codes are being assigned so that payer is accurately billed. Verifies diagnoses and procedures with the coding department to avoid discrepancies. Other Duties May review and analyze the SSI billing reports to ensure accurate billing and receipt of claims. Reviews the SSI Claims to ensure that claims have been received by the payor, if not research to see why claim(s) has not been received by the payor. Performs other related duties as required. Look for any trends with payor(s) or denials, that are seen while performing daily follow-up, and report to Revenue Cycle Manager. Work as a team and for the benefit of the whole department. Physical Demands This job operates in a professional office environment. This role routinely uses standard office equipment. 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. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; talk or hear. The employee must occasionally lift or move office products and supplies, up to 20 pounds. Must be able to see with corrective eye wear. Must be able to hear clearly with assistance. May be exposed to infectious and contagious diseases. May be in contact with patients under a variety of circumstances. Able to handle emergency or crisis situations. May be occasionally subject to irregular work hours. May be required to wear protective equipment as necessary. Ability to pass all required health and other screening tests including random and reasonable suspicion drug screens. #J-18808-Ljbffr