Medical Billing Specialist

About the role

The Medical Billing Specialist is a higher-level billing role within the Hospital or Physicians Billing Offices for the Albany Med Health System (AMHS). This role is centered predominantly around denials.

Responsibilities

• Resolve all levels of denials. The more complicated denials may require research and outreach to understand what is required to resolve.
• Professional appeal submission with supporting documentation. This may also require second level appeal submissions which will require stronger reasoning and or additional documentation.
• Identify and present the payer trends amongst the claims that are denying. Communicate and work with the leaders to mitigate.
• Present appropriate accounts for payer agendas with clear rationale and supporting documentation.
• Ability to be the learning partner for peers. Supportive and positive demeanor when mentoring.
• Manage and complete assigned projects timely. Present findings to leadership with suggestions to improve the process.
• Proper and detailed notation of actions taken on the account. Others will rely on those notes when taking the next step on the account follow up.
• Payer Website navigation as needed to obtain information.
• Review, understand, and locate payer policy guidelines as required.
• Able to locate claim adjudication details with the supporting documentation.
• Proficient use of Epic, OnBase, and other platforms as needed.
• Introduction and proficiency in running Epic reports will be required.
• Able to work independently and under time constraints and deadlines and with minimal supervision.
• Able to prioritize workload in an effective manner.
• Bring resolutions to management.
• Meet daily/weekly productivity standards with acceptable QA results.

Qualifications

• High School Diploma/G.E.D. - required
• Associate's Degree - preferred
• 2+ years medical billing experience - required
• Strong Epic Resolute billing experience - required
• Ability to work independently and within a team
• Excellent verbal and written communication skills.
• Ability to communicate with internal peers and leadership
• Demonstrates an ability to learn and understand instruction
• Ability to effectively prioritize and execute tasks in a high-volume atmosphere.
• Microsoft Office and website knowledge
• CCS-Certified Coding Specialist
• Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC)

Benefits

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.