Medical Billing Specialist

Overview

This position aids in properly capturing charges and correctly billing for services performed. The Medical Billing Specialist minimizes department rework, reprocessing of multiple claims from misaligned coding, and tracks and trends repeated missed opportunities for compliant charging and proactively finds and/or provides input regarding tools to streamline and/or improve charging processes.

Responsibilities

• Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges.
• Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems.
• Reviews denial trends for documentation or charging issue opportunities.
• Interacts with clinical departments to obtain additional information needed to properly bill accounts based on medical records.
• Identifies charging, coding, or clinical documentation issues and work with clinical departments to resolve issues and notify appropriate leadership.
• Analyzes business processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future cash losses and to optimize reimbursement.
• Aids in developing departmental program planning, strategy, and goals for increased revenue reimbursement.
• Supports Management by providing information, locating data sources and collecting data under tight time constraints.
• Assists with special projects as assigned.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement form insurance payors.
• Identifies and communicates trends and/or potential issues to the management team.
• Prioritize work to maximize turn-around time.

Qualifications

• Education: High School diploma or equivalent
• Prior Experience: 5 years medical billing experience preferred, Ophthalmology background desired but not required, CPC-A or CPC Certification preferred

Skills And Proficiencies

• Strong background and experience in Revenue Cycle Management
• Active knowledge of CMS guidelines contracted insurance guidelines and coding policies
• Demonstrated computer literacy
• Well-organized with attention to detail
• Strong math skills
• Ability to establish and maintain effective working relationships with team members, clinic staff, payers and patients
• Professional customer service skills
• A desire and dedication to work with self-discipline
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations