Medical Billing Specialist (69496)

Summary Of Duties And Responsibilities

The Medical Billing Specialist is responsible for reviewing daily charges and adjustments entered for accuracy, filing third-party claims, self-pay patient billing, and answering billing questions from patients and staff.

Primary Duties And Responsibilities

• Reviews assigned claims daily to ensure accuracy prior to claim submission.
• Reviews documentation on self-pay claims to ensure that the appropriate discount is applied. Makes billing corrections and adjustments to claims as appropriate to ensure prompt payment and accuracy of balance.
• Validates the correct payer for claim as well as verifies patient eligibility when in question.
• Contacts patients for missing information or clarification of documentation.
• Requests documentation and/or information required to process claims; scans and uploads documentation and information to patient accounts as applicable.
• SUBMIT CLAIMS TO CLEARINGHOUSE DAILY.
• Processes secondary and tertiary claims accurately and timely to ensure payment.
• CORPORATES WITH THE CLAIMS RESOLUTION SPECIALISTS TO ASSIST IN INVESTIGATING DENIED CLAIMS AND CREDIT BALANCES.
• Completes REJECTION AND REBILL REQUESTS.
• FOLLOWS UP ON PENDING CLAIMS AND WORK TO RESOLUTION.
• ASSISTS WITH PATIENT PHONE CALLS REGARDING BALANCES AND BENEFITS; ADVISES PATIENTS OF DEDUCTIBLES AND CO-PAYMENT STATUS.
• ASSISTS PATIENTS WITH PAYMENT ARRANGEMENTS BY COORDINATING WITH A COLLECTION SPECIALIST.
• ISSUES INDIVIDUAL STATEMENTS WHEN NECESSARY ON PATIENT ACCOUNTS.
• ASSISTS THE FRONT STAFF WITH BILLING AND ELIGIBILITY RELATED QUESTIONS.
• KEEPS ADEQUATE WITH DENTAL, BEHAVIOR HEALTH, AND VISION CLAIMS AND PROCESSES.
• METES ESTABLISHED DAILY, WEEKLY, MONTHLY, AND ANNUAL DEADLINES.
• UPHOLDS MEDICARE, MEDICAID, AND HIPAA COMPLIANCE GUIDELINES IN RELATION TO BILLING, COLLECTIONS, AND PHI INFORMATION.
• FOLLOWS WRITTEN AND VERBAL INSTRUCTIONS FROM THE MANAGER OF REVENUE CYCLE MANAGEMENT.
• EXHIBITS PROFESSIONALISM IN COMMUNICATION WITH PATIENTS, CLIENTS, INSURANCE COMPANIES AND CO-WORKERS.
• PARTICIPATES IN SPECIAL PROJECTS.
• SUPPORTS VARIETY CARE’S ACCREDITATION AS A PATIENT CENTERED MEDICAL HOME AND OUR COMMITMENT TO PROVIDE CARE TO ALL VARIETY PATIENTS THAT IS SAFE, EFFECTIVE, PATIENT CENTERED, TIMELY, EFFICIENT, AND EQUITABLE.
• PROVIDES LEADERSHIP AND WORKS WITH ALL STAFF TO ACHIEVE THE GOALS OF THE “TRIPLE AIM” OF HEALTHCARE REFORM—TO IMPROVE THE EXPERIENCE OF CARE, IMPROVE HEALTH OUTCOMES, AND DECREASE HEALTHCARE COSTS.
• EMBODIES THE STRENGTH OF PERSONAL CHARACTER.
• PLACES VALUE ON BEING AN OPEN AND HONEST COMMUNICATOR WHO DISPLAYS HIGH MORAL AND ETHICAL CONDUCT, INTEGRITY, ADAPTABILITY, AND SOUND JUDGMENT.
• MUST BE A LEADER IN THE DEPARTMENT AND COMMUNITY.
• RESULT-ORIENTED PROBLEM SOLVER WHO IS RESPONSIBLE AND ACCOUNTABLE.
• PERFORMS OTHER DUTIES AS ASSIGNED.

Essential Functions

• MUST BE ABLE TO LIFT 25 POUNDS.
• MUST BE ABLE TO SIT FOR EXTENDED PERIODS OF TIME.
• MUST HAVE EXCELLENT CONCENTRATION ABILITY.