Billing Specialist

The Billing Specialist role requires critical thinking and attention to detail. This position is responsible for timely submission/follow-up on claims for all payer types and multiple specialties. The Billing Specialist's role focuses on maximizing revenue and cash flow by completing these tasks promptly and efficiently.

• Resolve all charges in the Charge Review Work queue daily.
• Resolve all assigned claims in the Claim Edit Work queue daily.
• Resolve all payor rejections in the Follow Up Work queue within 10 working days.
• Research and rebill/resolve all claim denials within 60 days of the date of the denial.
• Research and rebill all claims with no response from the payor within 60 days of the date billed.
• Monitor AR days for assigned departments, maintaining AR days no greater than 45 days.
• Independently work to resolve claim denials to obtain payment.
• Process appeals within the timely filing requirements of the payer contract.
• Research credit balances to determine if a refund is required. Submit refund requests as needed.
• Document all actions on accounts in the EHR with clear, complete, and accurate notes.
• Contribute to the Billing Department team through positive attitude, respectful interaction, innovative ideas, efficiency, and ethical behavior.
• Participate in educational activities and attend team meetings.
• Maintain strict confidentiality; adhere to all HIPAA and PHI guidelines/regulations.

• Must have 2+ years of revenue cycle experience working in a medical setting; knowledge of ICD-10, CPT Codes, and HCPC Codes.
• Working knowledge of insurance payment regulations, including reimbursement, co-insurance, and deductibles, and contractual adjustments (Medicare, Medicaid, managed care, commercial insurance, and workers' compensation.
• Possess a working knowledge of practice management systems and Microsoft Office.
• Working knowledge of HIPAA and PHI regulations and compliance.
• Strong interpersonal and communication skills to be able to work successfully in team-oriented environments.
• High attention to detail and the ability to multitask.
• Minimum Education Level: High School Diploma/GED.
• 2 years of experience in a medical office setting preferred.