Medical Billing Specialist

The Medical Billing Specialist is a key member of the financial team at the Chicago Center for Sports Medicine & Orthopedic Surgery. This role is primarily responsible for ensuring accurate and timely processing of insurance payments, conducting appeals on improperly processed claims, and maintaining diligent follow-up on outstanding claims and denials. The Specialist will also assist with coding issues and patient inquiries regarding billing. Key Responsibilities: Payment Posting: Accurately post insurance payments from mail batches and electronic funds transfers (EFT) from various sources, including websites and ECW EFTs. Review and reconcile payment entries to ensure that all payments are accounted for and properly posted. Claims Management: Conduct thorough follow-ups on all outstanding insurance claims to ensure timely reimbursement. Investigate and appeal underpaid or denied claims by gathering necessary documentation and submitting detailed appeals to insurance companies. Proactively manage the Payer Denied Bucket by reviewing and resolving denied claims from commercial insurances. Appeals and Rejections: Handle mail batch rejections by reviewing the reason for rejection, correcting any issues, and resubmitting the claims. Track the status of appeals by monitoring the appeal bucket and performing regular follow-ups until the appeal is resolved. Coding and Compliance: Assist with coding issues by reviewing and suggesting appropriate corrections to ensure accurate billing and compliance with medical coding standards. Communication and Customer Service: Respond to patient inquiries, providing clear explanations of benefits and answering insurance-related questions. Ensure timely and professional responses to emails and voicemails related to billing inquiries. Surgical and Commercial Billing: Handle billing for surgical procedures, ensuring accuracy and completeness of all claims. Manage commercial billing processes, including claim submission and follow-up. Cross-Training and Collaboration: Be cross-trained and serve as a backup for various billing positions within the department, maintaining the flexibility to support different functions as needed. Administrative Support: Complete actions and telephone encounters promptly, maintaining a high standard of patient service. Participate in special projects and perform additional duties as assigned by supervisors or management to support the billing department. Qualifications: Associate or bachelor's degree in finance, accounting, healthcare administration, or a related field is preferred. Certification in medical billing and coding is highly desirable. Minimum of 2 years of experience in medical billing, specifically in an orthopedic or similar specialty practice. Proficiency with medical billing software, preferably ECW (eClinicalWorks), and a solid understanding of EFTs. Knowledge of medical terminology, ICD-10, and CPT coding. Strong analytical skills and attention to detail. Excellent communication and customer service skills, with the ability to explain complex billing issues in understandable terms. Ability to manage multiple tasks and prioritize work to adhere to deadlines and patient service standards. The Medical Billing Specialist at Chicago Center for Sports Medicine & Orthopedic Surgery is integral to our team, ensuring the practice's financial health through meticulous billing management and exceptional patient service. #J-18808-Ljbffr Primus Hospital