Medical Billing Specialist

Medical Billing Specialist

This position aids in properly capturing charges and correctly billing for services performed. The Medical Billing Specialist minimizes department rework, reprocessing of multiple claims from misaligned coding, and tracks and trends repeated missed opportunities for compliant charging and proactively finds and/or provides input regarding tools to streamline and/or improve charging processes.

MAIN:

• Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges.
• Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems.
• Perform root cause analyses, when warranted by continuous trends, to pinpoint areas, process gaps and continue to monitor and remediate any trends of charge leakage or overcharges.
• Review denial trends for documentation or charging issue opportunities.
• Interact with clinical departments to obtain additional information needed to properly bill accounts based on medical records.
• Identify charging, coding, or clinical documentation issues and work with clinical departments to resolve issues and notify appropriate leadership.
• Analyzes business processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future cash losses and to optimize reimbursement.
• Assists with developing departmental program planning, strategy, and goals for increased revenue reimbursement.
• Supports Management by providing information, locating data sources and collecting data under tight time constraints.
• Assist with special projects as assigned.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement form insurance payors.
• Identifies and communicates trends and/or potential issues to the management team.
• Prioritize work to maximize turn-around time.
• Performs all other assigned duties.

GENERAL DUTIES:

• Conducts self in accordance with the company's standard values and policies.

Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels. Medical Billing Specialists must attend webinars, classes, lectures, internal meetings, etc. to maintain current knowledge regarding CMS reimbursement, commercial payer contracts, charging policies and changes that impact revenue, such as CPT and coding changes.

Qualifications:

• High School diploma or equivalent

Prior Experience:

• 5 years medical billing experience preferred
• Ophthalmology background desired but not required
• CPC-A or CPC Certification preferred

Skills and Proficiencies:

• Strong background and experience in Revenue Cycle Management.
• Active knowledge of CMS guidelines contracted insurance guidelines and coding policies.
• Demonstrated computer literacy
• Well-organized with attention to detail
• Ability to read and understand oral and written instructions
• Excellent math skills
• Ability to establish and maintain effective working relationships with team members, clinic staff, payers and patients.
• Professional customer service skills.
• Have a desire and dedication to work with self-discipline.
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.

This role does require you to be in office with the potential to go hybrid.

Benefits & Perks:

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!