Medical Billing Specialist

Medical Billing Specialist

The Medical Billing Specialist reports to the Revenue Cycle Manager and is responsible for various tasks to ensure efficient billing, follow up, payment processing, and patient communication activities to maximize revenue.

Essential functions of the job include, but are not limited to, medical and dental insurance understanding of coordination of benefits, claims processing, and follow up. Utilizing a computer for data entry, conducting research, electronic communications, attending meetings, drafting and distributing reports, interacting with others, reconciling data, creating and updating spreadsheets. Communicating with others is an essential job function.

Major areas of responsibilities include working in EMR system's workqueues to process claims per coordination of benefits, reviewing billing reports; ensuring timeliness and accuracy of all claim submissions and billing procedures, preparing and submitting clean claims to various insurance companies to include both paper and electronic, extensive insurance follow-up and working knowledge of the appeals resolution process is required, responsible for contacting insurance companies and navigating insurance websites to secure and expedite payments, assisting in payment research in a timely and accurate manner, answering billing inquiries from patients, clerical staff and insurance companies, identifying and resolving patient billing complaints, assisting with patient inquiries for revenue department, reviewing assigned workqueues daily to ensure claims are timely, evaluating patient's financial status and rebill claims in conjunction with team and third-party billing company, follows and reports status of delinquent accounts, performing various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers as appropriate in conjunction with Epic/Ochin, participating in educational activities and attends monthly staff meetings, maintaining strict confidentiality; adheres to all HIPAA guidelines/regulations, and performing other duties for Finance Department.

Education/Licensure: High school diploma and medical billing required. Dental and/or Medical Coding Certification preferred but not required.

Knowledge, Skills, Abilities and other Qualifications: High school diploma required. Three to five years of medical experience in a medical office setting and a combination of training and experience required. One to Three years of experience in insurance billing and/or equivalent combination of training and experience preferred. Medical Billing and Coding knowledge and/or education equivalent combination preferred. Experience with Behavioral Health, Pharmacy, & Dental a plus. Must have strong knowledge of CPT and ICD-10 coding along with basic medical terminology skills required. Experience with EMR (Electronic Medical Record) and medical billing software preferred. (Epic or Epic/Ochin experience is preferred). Understanding of HIPAA compliance. Knowledge of FQHC, Federal Qualified Health Care Centers Billing preferred. Knowledge of third-party operating procedures and practices. Understanding of Commercial payer guidelines and denial management. CMS/Medicaid/Medicare of OH claims and COB experience preferred. Understanding of coordination of benefit requirements and credentialing with payers. Proven record of accomplishment of exceeding goals; evidence of the ability consistently making good decisions through a combination of analysis, experience and judgment; abilities in problem solving, project management and creative resourcefulness. Must be proficient in use of Microsoft Office (Access, Excel, Word and Outlook). Ability to work in a fast-paced, deadline-driven, changing environment. Manages multiple demands, work well under pressure and work independently. Highly organized multi-tasker who sets individual and team priorities and effectively monitors progress towards achievement. Must possess sound business judgment, exercise professional conduct, understand and follow business ethics and standards, and maintain a high level of confidentiality in all duties. Must possess outstanding verbal and written communication skills along with strong interpersonal and organizational abilities. Ability to function effectively as a member of a team, and a willingness to participate in activities and assignments that will benefit other members of the team or will contribute to the accomplishment of team objectives. Must be able to establish and maintain professional, productive and courteous interactions with employees that promote positive teamwork, as well as with constituents of the organization. This encompasses going beyond giving and receiving instructions and includes but is not limited to (a) performing work activities requiring interacting or speaking with others, and (b) responding appropriately to constructive feedback or suggestions for improvement from a supervisor. Must have sensitivity to, interest in and competence in cultural differences, HIV/AIDS, minority health, sexual practices, and a demonstrated competence in working with persons of color, and gay/lesbian/bisexual/transgender community. Professional appearance and demeanor.

Other information: Background and reference checks will be conducted. In accordance with Equitas Health's Drug-Free Workplace Policy, pre-employment drug testing will be administered. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment. EOE/AA