Senior Medical Billing Specialist- Belmont, NC

Compleat KiDZ / Kare Partners is seeking an experienced Senior Medical Billing Specialist to join our growing team in our Belmont, NC office. This is not a remote position.

About the Role

The Senior Medical Billing Specialist must demonstrate an exceptional understanding of billing-related functions. As a senior-level specialist, you will work closely with the Medical Billing Team to ensure payment is secured for all services by timely filing of secondary/tertiary insurance billings, follow-up, denials, reconsiderations, and appeals until all claims are fully adjudicated.

Responsibilities

• Act as point of contact for eligibility and third-party billing questions and processes.
• Process NC Medicaid, Medicare Part A & B, and private insurance claims.
• Review all claims for completeness, reasonableness of charges, appropriateness of billing codes, and payer information.
• Review referrals and pre-authorizations as required for payment of outstanding dates of service.
• Ensure claims meet regulatory requirements.
• Pursue timely collection of each claim using thorough follow-up efforts appropriate to each payer, and follow up on insurance claim denials and exceptions or exclusions.
• Read and interpret insurance explanations of benefits.
• File appeals when appropriate to obtain maximum reimbursement.
• Perform insurance verification and recheck eligibility and benefits verifications for outstanding dates of service.
• Conduct billing utilizing the most efficient resources to secure timely payment of open claims or invoices, prioritizing electronic solutions.
• Review and work from developed aging and denial reports for resubmission of claims to the correct insurance carrier.
• Review patient bills for accuracy and completeness and obtain any missing information.
• Make necessary arrangements for medical records requests and completion of additional-information requests as requested by insurance companies.
• Provide timely responses to inquiries from insurance companies, patients, and providers.
• Regularly meet with the VP of Revenue Operations to discuss and resolve reimbursement issues or billing obstacles.
• Attend weekly/monthly staff meetings and continuing-education sessions as requested.
• Contact insurance companies by phone and/or submit letters of appeal to collect outstanding payment and obtain maximum reimbursement.
• Follow up on unpaid claims within the standard billing-cycle timeframe.
• Check each insurance payment for accuracy and compliance with contract discount.
• Identify and bill secondary or tertiary insurances as needed.
• Review all accounts for insurance or patient follow-up.
• Research and appeal denied claims.
• Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
• Perform additional duties as requested by Management.

Requirements

• Associate degree or above.
• Minimum of three years of experience in a medical billing specialist role.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
• Experience using coding - ICD-10 and CPT codes - as well as medical billing forms UB-04 and CMS-1500.
• Working knowledge of North Carolina Medicaid billing and the NCTracks system.
• Basic computer experience; familiar with the Microsoft Office Suite.
• Strong process and analytical skills.
• Excellent written, verbal, and organizational skills.
• Ability to adapt to changing organizational needs.
• Ability to manage relationships with various insurance payers.
• Ability to meet strict deadlines.
• Responsible use of confidential information and understanding of HIPAA compliance.
• Ability to multi-task and work courteously and respectfully with fellow employees, clients, and patients.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; use hands to finger, handle, or feel; and reach with hands and arms. Lifting, pushing, and pulling are also required.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

Benefits

• Medical, dental, and vision coverage
• HSA (Health Savings Account)
• STD (Short-Term Disability) and LTD (Long-Term Disability)
• Life insurance
• EAP (Employee Assistance Program)
• Company-matched 401(k)
• Paid vacation and holidays