Medical Billing Specialist

Medical Insurance Claims Processor

This position is responsible for prompt, accurate, and effective medical insurance claim submission, with follow-up of claims to satisfactory resolution.

Essential Functions:

• Review medical documentation and assess for proper coding utilizing CPT, HCPCS, and ICD10 coding materials, working closely with providers and other medical staff to ensure accuracy.
• Submit clean claims to all payer types for prompt return of accounts receivable.
• Follow-up on unpaid claims and resolve any billing issues in a timely manner.
• Stay current on coding and billing guidelines for all payer types, to include commercial, government, and worker's compensation.
• Identify accounts which may require a refund and process appropriately.
• Manage claims through various online tools and reporting systems.
• Identify education needs for providers and medical staff based on coding assessments and/or updates, and act accordingly.
• Assist patients with billing questions and issues, to include guidance on office policies regarding sliding scale discounts and payment arrangements for outstanding balances.
• Post payments in practice management system, maintain batch controls and run reports appropriately.
• Assist front office staff with billing questions relating to proper registration and scheduling of appointments as needed.
• Participate in projects, trainings, and office/staff meetings.
• Follow all Aviva Health policies and procedures.

Qualifications:

• High School Diploma or GED required.
• Minimum of one year experience in medical billing utilizing ICD-10, CPT, and HCPCS coding.
• Excellent written and oral communication skills.
• Certification in medical coding/billing preferred.

Working Conditions:

Must be able to perform the following physical requirements:

• Remain in a stationary position frequently throughout the day while performing duties.
• Move or traverse occasionally throughout the day throughout the worksite.
• Operate equipment frequently throughout the day: computer, phone, printer, standard office equipment.
• Ability to communicate information and ideas clearly and accurately so others will understand; ability to interact with patients and staff clearly.
• Able to move or transport up to 5 pounds while transporting laptop computer.
• Work on-site indoors in heat-controlled environment frequently throughout the day.
• OSHA Exposure Category – Category #2: The normal work routine involves no exposure to blood, body fluids, or tissues.
• Onsite work in office.
• Normal business hours.
• If employee becomes eligible to work remotely, periodic travel to the office for work is required and a remote work agreement and regular home office safety inspections are required.

Disclaimer: Employees must be able to perform the essential functions of their position satisfactorily. Aviva Health will make reasonable efforts to accommodate a qualified applicant or employee with a known disability unless such accommodation creates an undue hardship on the operation of the business. To request a reasonable accommodation, please contact the Human Resources Director or their designee by email.