Medical Billing Specialist

Medical Billing Specialist Multiple positions available Requirements - High School Diploma or GED - Associate degree in Health Information technology preferred - Billing certification or applicable experience would be helpful. Skills/Experience: 1. At least (2) two years of billing experience preferred with heavy focus on denial reimbursement. 2. A background in hospital and/or medical facility preferred. 3. Proficient experience in timely filing guidelines and appropriate denial procedures for Medicare, Medicaid, and Commercial Insurance. 4. Fundamental recognition of basic medical coding and third-party operating procedures and practices. 5. Fluency in revenue cycle management procedures and protocols. 6. Ability to navigate and perform billing functions in the PM system(s) and clearinghouse (eClinical Works, HPM, Allscripts, NextGen, Intergy, Athena experience preferred.) 7. Proficient command of the revenue cycle management process 8. Knowledge of business office procedures. 9. Comprehensive understanding of how to process paper and electronic medical claims. 10. Operate a computer and basic office equipment. 11. Operate a multi-line telephone system. 12. Interprets, understand and follow oral and written instructions. 13. Ability to establish and maintain working relationships with insurance company representatives, colleagues, clients, and patients if needed. The Billing Specialist is a detail-oriented professional with health information management experience including revenue cycle management with a proven track record working timely claim denials. This Synergist will be an expert in the field of denial recovery using applicable health information guidelines to adjudicate claims from submission to reimbursement. This Specialist will have knowledge of payers including Medicare, Medicaid and Commercial insurance processes maintaining the integrity of all health data. The purpose of the Billing Specialist is to pursue Zero AR, ensuring that all denials are actioned resulting in a reduction in AR. Direct Supervisor: Reports to Zero AR Manager. Essential Functions May Include: Denial Prevention 1. Ensure that claims are exported from the PM system and imported to WorkSmart MD in accordance with contractual obligations. 2. Examine claim data and visually identify errors within the PM system, WorkSmart MD, and the clearinghouse that will lead to paid claims. 3. Ensure that all claims are exported from WorkSmart MD into the clearinghouse and accepted by the payer. 4. Maintaining the clearinghouse including submission of claims and reviewing responses from both the clearinghouse and each respective payer. 5. Report on any errors that prevent claims from being received and accepted by the payer. 6. Document recurring issues on the Issues Log preventing full reimbursement. Document updates and overall resolution of the issue on the Issues Log. 7. Maintaining the privacy and security of protected health information and adhering to all HIPAA guidelines/regulations. Zero AR 1. Ensure that all denials are reviewed, diagnosed and actioned within 30 days of remittance advice receipt. 2. Ensure that all denials that were previously worked and are not paid and still on the AR exceeding 30 days of action are reviewed, diagnosed and actioned. 3. To review claims that have been submitted and have no remit greater than 60 days of service. 4. Document recurring issues on the Issues Log preventing full reimbursement. Document updates and overall resolution of the issue on the Issues Log. 5.Taking contractual adjustments based on remittance advice from payer to ensure patient account balances are accurately reflected. Environmental/Working Conditions: Requires sitting and standing associated with a nor al office/classroom environment. Manual dexterity is needed for using a calculator and computer keyboard. Occasional classroom environment and over-time may be required and/or hours may be shortened as business needs dictate. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve.