Medical Billing Specialist

About the Role

The Medical Billing Specialist for Nurse Practitioners processes and transmits claims, tracks claim status, monitors payor authorization and eligibility, manages collections, and posts cash receipts.

Responsibilities

• Extract and verify billing information from medical records
• Ensure collection of past due balances; follow up as needed
• Verify all patient demographic and insurance data before submitting claims to insurance companies
• Answer patient account inquiries and establish alternative payment plans when necessary
• Maintain patient account records and resolve third-party payer issues
• Receive and review Daily Reconciliation Review (DAR) document for accuracy; enter charges into Practice Management System (PMS)
• Prepare and review patient statements prior to release through PMS
• Ensure timely filing of all Medicare, Medicaid, and third-party insurance claims
• Balance daily charges and reconcile with reports within PMS
• Collaborate with revenue cycle manager and payers on denials/rejections
• Work closely with practice representatives to ensure proper insurance verifications and authorizations
• Comply with applicable legal requirements, standards, policies, and procedures, including Corporate Compliance Program, HIPAA, and Federal False Claims Act
• Report concerns and suspected incidences of non-compliance immediately to the Chief Compliance Officer
• Participate in required orientation, training programs, monitoring, and audit functions
• Handle other duties as assigned

Requirements

• Communicate professionally with patients and guarantors regarding balances or account information
• Participate in process improvement responsibilities
• Meet productivity goals
• Handle multiple priorities effectively
• Successful completion of required training

Skills

• Problem-solving skills to manage a variety of concrete variables
• Effective verbal and written communication skills
• Ability to interpret instruction presented in a variety of situations
• Strong organizational skills; ability to manage multiple projects simultaneously
• Proficiency with Microsoft Word, Excel, PowerPoint, and Internet Explorer
• Ten-key speed and accuracy