Medical Billing Specialist

Medical Insurance Billing Specialist

Responsible for billing and processing insurance payments; investigating needed information regarding denied claims with timely follow-up with insurance payers; interpreting the patient account regarding billed codes and chart documentation; communicating with patients and/or guarantors about outstanding balances by phone or mail to collect balances; establishing and monitoring payment plans; documenting all follow-up with insurance payors and patients in the billing software.

Account Reviews

• Reviews assigned patient schedules to ensure information for insurance claims to include patient demographics, insurance information, diagnosis and treatment codes/modifiers and provider information is complete and accurate.
• Submits insurance claims through billing software's clearinghouse vendor.
• Understands Managed Care Authorization process as required per individual plan; notifies Authorization Department if an authorization is missing, incomplete, or if insurance changed.

Insurance Follow-Up

• Follows up with insurance payer on unpaid, underpaid or rejected claims.
• Reviews Denial Report daily; responds to non-payment reason codes; refile claims as needed.
• Checks for maximum reimbursement for services and providers.
• Prepares appeal letters needed to support any unpaid claims with needed documentation.
• Ensure that secondary claims have been submitted for patients with more than one insurance.
• May assist with re-verification of patient benefits, eligibility and coverage as needed.

Patient Responsible Balances

• Determines patient responsible co-pays, deductibles, and co-insurance.
• Prepares a weekly Patient Balance Log for the Clinic Front Desk to use to collect patient responsible balance.
• Establishes payment plans for past due balances; monitors collections; documents payment plan in the billing software.
• Performs'soft collections' for patient past due accounts to include a letter and/or phone call.

Posting

• May assist with posting patient payments.

Medicare Reviews and Audits

• Assist with reviews and audits as needed or assigned.

Minimum Qualifications

• High School Diploma or GED.
• At least three (3) years of Medical insurance billing and coding experience.
• Basic understanding of medical ICD 10 and CPT medical billing codes.
• Knowledge or experience with Wound Care and Hyperbaric Therapy, preferred.

Essential Responsibilities

• Proficient use of computers, Microsoft Office, and common office equipment.
• Good verbal and written communication skills.
• Detailed oriented and ability to prioritize work assignments; able to work independently.
• Familiarity with HIPAA privacy requirements regarding patient information.

US Wound Care and Hyperbaric Centers is an equal employment opportunity employer and considers qualified applicants for employment without regard to race, gender, age, color, religion, national origin, marital status, disability, sexual orientation, protected military/veteran status or any other protected factor.