Specialist, Billing

Essential Job Duties and Functions

• Perform and monitor all steps in the billing processes to ensure maximum reimbursement from patients, government and commercial payers as well as from special billing arrangements
• Prepare and submit clean claims to third party payers either electronically or by paper
• Follow billing guidelines and legal requirements to ensure compliance with federal and state regulations
• Respond to account inquiries from patients, payers, providers, and/or other staff as requested
• Identify and resolve patient/insurance billing issues
• Work closely with team members regarding claim appeals, denials, resolution, and education
• Understand Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Update providers, learners, office staff, clinics, and faculty of changes as appropriate
• Contribute to the areas for coding, billing, and documentation education that is being reviewed for all providers and residents, related to billing coding and errors
• Contribute to new learner education related to billing and collections
• Understand the considerations of coding in Value Based payment contracts
• Review and implement changes from payer bulletins
• Use online healthcare databases and other resources for verification and claim status
• Deliver the highest quality service to internal and external customers
• Assist other members of the team with projects as needed
• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations

PREFERRED QUALIFICATIONS

• Certified Biller
• FQHC Billing