Billing Specialist

Billing Specialist IThe Billing Specialist I 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 ResponsibilitiesEnters information necessary for insurance claims such as patient, insurance, and insurance ID. Insures claim information in complete and accurate.Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.Answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc. Resolves patient's complaints or explains why certain services are not covered.Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims.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.May perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.Understand managed care authorizations and limits to coverage such as number of visits.Verify patient benefits eligibility and coverage as needed.Prepares and submits secondary claims upon processing by primary insurer.EducationHigh School Diploma or GED required.Work ExperienceMedical billing experience highly preferred. Experience in billing software and electronic data submission preferred.Certification/LicenseCertification/LicenseMental/Physical RequirementsAbility 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 ConditionsStandard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases. Aya Healthcare