Medical Billing Specialist

Claims Processor

A non-exempt hourly position that is responsible for the daily functions of ensuring claims are submitted to patient insurance, resolving claims that need additional follow-up in a timely manner, and resolving patient inquiries.

Full time position: 40hrs (M-F 8:00-5:00PM) IN OFFICE. THIS IS NOT A REMOTE POSITION.

Essential Job Responsibilities:

• Daily charge verification to include fee ticket and progress note reconciliation for accuracy
• Daily claims creation and submission
• Managing clearinghouse rejections
• Daily eligibility verification
• Denial Management
• A/R Follow-up
• ERA and manual EOB posting
• Patient Statement generation and management
• Processing and posting patient payments
• Customer Service- patient account inquiry and resolution (via email, phone, and in person)
• Other duties as assigned.

Education/Experience: Minimum of high school diploma with Five (5) years' experience in healthcare billing; or the completion of a medical billing coding school program.

Other Requirements: Billing, Collections & Coding Experience

Performance Requirements:

Knowledge:

• Knowledge of medical practices, terminology and reimbursement/payor policies.
• Knowledge of A/R workflows and requirements by insurance carrier
• Broad-based knowledge of relevant insurance regulations and familiarity with the Health Insurance Portability and Accountability Act (HIPAA).

Skills:

• Skill in planning, organizing and prioritizing.
• Skill in problem solving and conflict resolution.
• Skill in verbal and written communication.
• Skill in establishing and maintaining effective working relationships with other employees, policy making bodies, third party payers, patients, organizations and the public.
• Skill in analyzing situations accurately and taking effective action.
• Skill in organizing work, making assignments and achieving goals/objectives in a timely manner.

Abilities:

• Ability to read, interpret and apply policies and procedures.
• Ability to set priorities among multiple requests.
• Ability to interact with patients, medical and administrative staff and the public effectively.
• Ability to communicate in writing, over the telephone and in person with office staff, insurance representatives and patients.
• Ability to recognize, evaluate, solve problems and correct errors.

Equipment & Software Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones; eClinicalWorks (ECW), Excel, Word.

Potomac Pediatrics believes that each employee makes a significant contribution to the success of the practice. That contribution should not be limited by the assigned responsibilities; therefore, this position description is designed to outline primary duties, qualifications and job scope, but not limit the employee nor Potomac Pediatrics to the work identified. It is the practice's expectation that each employee will aid whenever necessary to ensure the success of the practice's endeavors.