Medical Billing Specialist

DESCRIPTION

We are seeking an experienced Medical Billing Specialist with a strong background in physician-office billing to join our team.


Job Description: Medical Billing Specialist - Physician Office

The ideal candidate will have hands-on experience with the full medical billing cycle and a solid understanding of billing requirements for Primary Care/Internal Medicine, Podiatry, and/or Nephrology .

Louisiana Medicaid physician-office billing experience is strongly preferred.

Essential Duties and Responsibilities: Submit and follow up on claims for Medicare, Medicaid, Medicare Advantage, Medicaid managed-care plans, and commercial insurance.

• Work claim rejections, denials, underpayments, and unpaid claims in a timely manner.
• Correct and resubmit claims when necessary, including corrected/adjusted claims and appeals.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to identify payment issues.
• Perform insurance follow-up and communicate with payers regarding claim status, authorization, eligibility, and payment issues.
• Maintain accurate accounts receivable and work aging reports to reduce outstanding balances.
• Identify recurring billing or denial trends and help implement solutions to improve clean-claim rates and reimbursement.
• Work closely with physicians, nurse practitioners, physician assistants, clinical staff, front-office staff, and management to resolve billing issues.
• Understand billing requirements involving supervising/rendering/billing providers, NP/PA services, and payer-specific credentialing requirements.
• Maintain compliance with HIPAA, payer guidelines, Medicare/Medicaid requirements, and company policies.

Qualifications:

• 2+ years of medical billing experience in a physician-office setting preferred.
• Strong knowledge of the complete revenue cycle, from claim creation through payment and denial resolution.
• Working knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and CMS-1500 professional claims.
• Experience working directly with insurance companies and payer portals.
• Ability to research payer policies and independently resolve complicated claim issues.
• Strong attention to detail and ability to identify billing errors before claims are submitted.
• Excellent organizational, problem-solving, and communication skills.
• Ability to manage a high-volume workload while meeting timely filing and follow-up deadlines.
• Experience with an electronic health record/practice-management system required; eClinicalWorks experience is a plus.

Competencies:

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical: Collects and researches data: Uses intuition and experience to complement data.

Design : Demonstrates attention to detail.

Problem solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Works well in group problem solving situations ; Uses reason even when dealing with emotional topics.

Technical Skills: Strives to continuously build knowledge and skills.

Customer service: Manages difficult or emotional customer situations; responds promptly to customer needs: Responds to request for service and assistance; Meets commitments.

Interpersonal Skill: Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; Keeps emotions under control; remains open to other ideas and tries new things.

Oral communication: Speaks clearly and persuasively in positive or negative situations; listens and get s clarification; responds well to questions; Participates in meetings.

Written Communication: Writes clearly and informatively; Edits work for spelling and grammar: Presents numerical data effectively; Able to read and interpret written information.

Leadership: Accepts feedback from others.

Quality Management : Demonstrates accuracy and thoroughness.

Diversity: Shows respect and sensitivity for cultural differences.

Ethics: Treats people with respect; keep commitments; upholds organizational values.

Organizational Support : Follows policies and procedures: Supports organization's goals and values; supports affirmative action and respects diversity.

Judgment: Displays willingness to make decisions; exhibits sound accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision- making process; Makes timely decisions.

Motivation- Demonstrates persistence and overcomes obstacles.

Planning/Organizing : Prioritize and plans work activities; uses time efficiently.

Professionalism: Approaches other in a tactful manner; reacts well under pressure; treats other with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.

Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.

Quantity: Meets productivity standards; completes work in a timely manner; works quickly.

Safety and Security: Observes safety and security procedures; reports on potentially unsafe conditions.

Adaptability: Adapts to changes in the work environment.

Attendance /Punctuality is consistently at work and on time; ensures work responsibilities area covered when absent; arrives at meetings and appointments on time

Dependability: Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of when necessary to reach goals. Completes task on time or notifies appropriate person with an alternate plan.

Initiative : Asks for offers help when needed.

Innovation: Displays original thinking and creativity; meets challenges with resourcefulness.

Qualifications : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Education and/or Experience: One-year certificate from college or technical school to six months related experience and/or training or equivalent combination of education and experience

Language Skills: Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondenceAbility to effectively present information in one-on-one and small group situations to patients and other employees of the organization.

Mathematical skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Reasoning Ability : Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructionsAbility to deal with problems involving a few concrete variables in standardized situations

Computer skills: To perform this job successfully, an individual should have knowledge of accounting /insurance billing software; Internet software and word processing software.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this jobReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk to hearThe employee is occasionally required to stand and walkThe employee must occasionally lift and /or move vision, peripheral vision and ability to adjust focus.

REQUIREMENTS

We are a dedicated medical team of primary care , specialists, and nurse practitioners. We provide medical services at several healthcare facilities including our state-of-the-art office, local acute care hospitals, rehabilitation hospitals, long-term acute care facilities, and Louisiana nursing homes.