Medical Billing Specialist

Claims Processing

• Reviews charge tickets and SOAP notes to ensure claims are prepared accurately.
• SUBMITs and processes all electronic claims through our third-party clearinghouse to ensure timely and accurate billing.
• PREPARES and distributes HCFA-1500 claim forms via mail for claims that cannot be submitted electronically.
• REVIEWS clearinghouse reports for rejected claims and IMPLEMENTS corrective actions to reduce future denials.
• RESPONDS to billing inquiries via email, fax, instant messaging, and phone in accordance with departmental policies; SUBMITS secondary claims with the primary payer’s explanation of benefits (EOB).
• COLLABORATES with the University of Georgia Athletic Department and Athletic Insurance Coordinator to ensure timely and accurate processing of charges for services rendered at the University Health Center, including medical, pharmacy, dental, and vision services.

Payments and Claims Follow-Up

• POST insurance payments accurately to ensure the account balance is correct.
• RESEARCHES, ANALYZES, and MONITORS unpaid claims to identify lost revenue related to coding errors, unbilled services, and incorrect reimbursements.
• MONITORS aging claims and COMMUNICATES with insurance carriers regarding claims exceeding 90 days.
• SUBMITS appeals for claims denied due to timely filing and PROVIDES documentation supporting timely submission through the EMR system.
• COMMUNICATE with patient and/or family member regarding insurance coverage and claim status, including appeal processes when appropriate.
• CORRECTS claims discrepancies and RESUBMITS claims to ensure proper resolution and reimbursement.
• MANTAINS and RECONCILES daily deposit records.

Customer Service Support

• ANSWERS incoming calls courteously and professionally, ensuring high level of customer service.
• ASSISTS callers by EXPLAINING charges within the Practice Management System (PMS) and ADDRESSES related inquiries.
• UTILIZES the PMS to EFFECTIVELY support inquiries related to balances, insurance details, diagnoses, billed amounts, adjustments, and payments.
• REVIEWS notes or other actions taken on accounts to RESOLVE inquiries efficiently and MINIMIZE unnecessary call transfers.
• ESCALATES complex issues to supervisor or other departments, providing RELEVANT account details and documentation.
• DOCUMENTS all telephone interactions thoroughly by ENTERING detailed notes into the system to ensure CONTINUITY of service.

Coding and Compliance Knowledge

• UNDERSTANDS Medicare, Medicaid, Tricare and other government payers as it relates to collections and billing.
• ENSURES patient accounts contain accurate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Statistical Classification of Diseases (ICD-10) codes are assigned to patient accounts by University Health Center (UHC) providers.
• EXTENSIVELY uses the Point N Click (PnC) information system, CPT, HCPCS and ICD coding manuals as well as various supporting resources related to coding and medical science.
• IDENTIFIES and ASSIGNs appropriate codes for new services.
• REVIEWS and REMOVES outdated codes from the Fee Schedule to MAINTAIN accuracy.
• COMMUNICATES coding updates and discrepancies to the Coding and Compliance Manager.