Billing Specialist

Responsibilities

• Sets up and submits claims to payers based on review of medical records and in accordance with Medicare, Medicaid, and Commercial insurance guidelines as well as FHCSWF policies and procedures.
• Reviews information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information to ensure clean claim submission.
• Enters charges accurately and expeditiously to ensure proper records handling and fast payment.
• Timely filing of insurance claims to clearinghouse or individual insurance companies electronically or via paper.
• Reviews and corrects claim edits within 24 hours of being received from clearinghouse and internal claims scrubber.
• Initiates private pay collections after insurance cancellation, denial or other issue and answers patient questions on patient responsible portions, copays, deductibles, write-offs, etc.
• Performs self-pay patient billing.
• Prepares and sends patient statements for charges not covered by insurance.

Requirements

• Demonstrated knowledge of Medicaid, Medicare, and Commercial Insurance rules and procedures in a managed care plan environment.
• Medical terminology, CPT, HCPCS and ICD-10 coding and modifier usage.
• Understanding of FQHC billing procedures and Sliding Fee Schedules (a plus).
• EHR systems expertise, preferably with Intergy or other ambulatory care facility-based system.
• Understand and adhere to all HIPAA guidelines.
• MS Office Suite (Excel proficiency).
• Alpha-Numeric data entry.