Billing Specialist

Billing Specialist II

The Billing Specialist II is responsible for collecting and entering claims, posting insurance, submitting claims, and answering patient inquiries on accounts. Reports to the Billing Supervisor.

Essential Duties and Responsibilities

• Enters information necessary for insurance claims such as patient insurance and insurance ID. Insures claim information is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Be a secondary resource to answer patient questions regarding insurance claims processing and insurance coverage/payment issues, which may include explanation of patient portion amounts such as, copays, deductibles, and contractual adjustments.
• Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims. If not able to resolve the issues, forwards the denial to DPR to review for appeal.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Follows HIPAA guidelines in handling patient information.
• Recognize managed care contract terms and reimbursement methodologies. Resolve under/over payment disputes with payers based upon contracted terms and reimbursement amounts received.
• Verify patient benefits eligibility and coverage, using the payer portal or contacting the payer directly, as needed.
• Ability to research and use electronic (websites or payer portals) or paper reference material to ensure that claims are submitted clean and on first pass to the payer. Also uses this reference material when following-up claims that need timely review.
• Insures the appropriate occurrence and condition codes have been applied to the claim.
• Refers coding issues to the appropriate coding staff.
• Submits replacement claims when late charges occur.
• Works with precert team with issues related to authorization issues.

Education

• Associate Degree in health care or other related field or certified in billing by an accredited organization required. Will consider years of medical billing experience in lieu of this requirement. High School diploma or GED required.

Work Experience

• 3 years medical billing experience required. Experience in billing software and electronic data submission preferred.

Certification/License

• Not required.

Mental/Physical Requirements

• Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds.

Working Conditions

• Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.