Medical Billing Specialist

Medical Billing Specialist

SPECIFIC RESPONSIBILITIES: Generate primary and secondary paper bills according to established procedures. Edit paper claims before mailing. Perform claim follow up on denials quickly and accurately from assigned payers to ensure revenues are received timely. Run 837 files according to established procedures. Resolve any validation issues Accurate and timely data entry into payer websites for original claim submissions and/or corrected claims submissions. Verify and post remittance from assigned payers. Re-bill accounts as necessary to ensure an open insurance receivable against which a payment can be applied. Thoroughly research questionable/unidentified payment in order to post properly or refund to payer per payer guidelines. Work with payers and subscribers to resolve issues and facilitate prompt payment of claims. Verify NAP issues and work to resolve. Identify and communicate to up-line delays effecting balancing issues, new codes, or adjustments. Identify and communicate to up-line any Psych Consult issues such as fee matrix, CPT codes, units or rates to eliminate inefficiencies and/or obstacles in billing process Reconcile funds in the bank to payments posted. Prepare adjustments such as refunds, contractual differences and write offs for approval and processing. Work open/billed reports and/or aged reports timely to ensure revenue is not lost. Monitor payer websites for benefit information and requirements. Timely communication to manager if our system needs updated for accurate billing. Follow up on corrected claims to ensure filing time guidelines are met. Receive incoming telephone and email inquires from patients, families, internal staff and insurance companies and resolve/refer appropriately. Efficiently and accurately documents detailed notes in Psych Consult Patient Accounts Screen and review notes documented by others before proceeding on issues. Forward all authorization issues/concerns to the Managed Care Coordinator timely to ensure revenue is not lost. Document in system. Communicate appropriately utilizing a service account. Support co-workers towards completion of assigned projects/tasks. Back up for clerical staff at Behavioral Health facilities as needed. Suggest new work flows and/or office procedures to increase customer satisfaction and/or staff productivity. Scan, OCR and redact in scanning software.

REQUIRED MINIMUM QUALIFICATIONS: High school diploma or equivalent is required. Associate degree in accounting field preferred. Minimum of four years experience in an accounts receivable environment with three years specific to health care billing including cash posting, submitting paper and electronic claims, working rejections/denials, required. Knowledge of insurance reimbursement guidelines for Medical Assistance, Commercial Plans, Medicare and Medicare HMO plans required. Knowledge of Allegheny County guidelines preferred. Proficient with personal computer base applications and other various office equipment. Good oral and written communication skills required. Conveys an outstanding first contact experience to all customers, including internal and external contacts. Performs multiple tasks. Proficient in task analysis and completion. Excellent organizational, time management, and follow-up skills. Maintains confidentiality with regard to all job assignments.