Accounts Receivable Billing Specialist

About the role

Under the direct supervision of the Director of A/R, the Medical Billing Specialist is responsible for processing timely, complete and accurate billing information in compliance with government and third party payers to ensure prompt and accurate reimbursement.

Responsibilities

• Prepare, review and process healthcare claims to the clearinghouse for the Managed Care Organizations (MCOs), Medicaid, Medicare and commercial insurance companies using billing software.
• Enter claims using CPT, ICD-10 codes and other medical terminology.
• Meet coding deadlines to expedite the billing process.
• Review all insurance payments for accuracy and compliance with the contract discount.
• Follow up on unpaid claims within the standard billing cycle.
• Identify, research, resolve and/or appeal denials, exceptions and exclusions.
• Manage patient and insurance inquiries.
• Maintain records of medical billing.
• Validate eligibility, benefits, deductibles and produce accurate documentation.
• Assist in the development and implementation of operational improvements.
• Continuously learn about healthcare coverage options and benefit plans.
• Communicate with management on payer trends identified.
• Enter payment posting and adjustments.
• Contribute to the development and maintenance of the Agency’s systems through the timely completion of assigned documentation and in accordance with applicable legal, fiscal, licensing and accreditation regulations and standards.
• Maintain current knowledge and skills through reading and utilizing coding resources; attend and participate in coding education systems.
• Respect the privacy of clients; handle all client material in accordance with Agency guidelines on confidential material.
• Perform ad-hoc analysis and reporting as necessary.

Requirements

• Education: Associates Degree preferred.
• Licensure/Certification: Medical coding certification preferred.
• Experience: 3–5 years related experience and/or training required; demonstrated accounts receivable and collection skills.

Competency/Skills

• Core Expertise: Possess skill, knowledge and abilities to perform the essential duties of the role; keep knowledge up to date.
• Independent Judgment: Demonstrate ability to perform job responsibilities with a high degree of initiative and independent judgment.
• Cultural Competency: Demonstrate awareness, sensitivity and skills in working professionally with diverse individuals, groups and communities who represent various cultural and personal backgrounds and characteristics.
• Interpersonal Communication: Communicate clearly using verbal, nonverbal, and written skills in a professional context; demonstrate clear understanding and use of professional language.
• Professional & Ethical Conduct: Adhere to professional values such as honesty, personal responsibility, and accountability; apply ethical concepts within scope of work and adhere to Agency policies and procedures.
• Collaboration and Teamwork: Function effectively as a member of a professional team that includes employees, clients and family members.
• Problem Solving & Decision Making: Recognize problems and respond appropriately; gather information and sort through it to identify and address root cause issues; make timely decisions.
• Service Orientation: Anticipate, recognize, and meet the needs of others, whether they are clients or not.
• Technical Proficiency: Demonstrate competence in utilizing Agency computer systems and software as required to perform essential job functions.