Medical Billing Procedure Claims Specialist

Job Duties

• Audits and ensures claim information is complete and accurate.
• Claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
• Accurately and timely bills HCFA 1500 claims.
• Ensures files are documented with appropriate information (date stamped, logged, signed).
• Creates logs for providers of pending medical encounters and/or encounters with errors.
• Works directly with other billing staff and management to meet end-of-month closing deadlines.
• Addresses clearinghouse rejections, prints, and mails secondaries.
• Communicates with insurance companies, patients, and providers.
• Understands CPT, ICD10, HCPCS coding and modifiers.
• Knows third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker’s Compensation, etc.
• Knows ERA, EOBs, payer-specific/LCD guidelines.
• Understands health plan benefits (deductibles, copays, coinsurance) and eligibility verification.
• Proficient with spreadsheets and word processing applications.

Qualifications

• Minimum of 3 years’ experience with medical billing or revenue cycle in a medical setting.
• Experience with Medicare, Medicaid, Commercial insurance plans, Workers’ comp, and Personal Injury cases.
• Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
• Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials.
• Excellent knowledge of CPT coding, ICD10 coding, and medical pre-certification protocols required.
• Excellent computer skills and familiarity with Microsoft Office.
• Comfortable working in a growing, dynamic organization and able to navigate change.
• Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment.
• Bachelor’s degree preferred.
• Experience using eClinicalWorks preferred.
• Experience with high-level procedure billing and coding for Pain Management preferred.

Pay

Competitive salary.

Schedule

Full-time.

Benefits

• PTO
• Health benefits
• 401k match