BILLING SPECIALIST

OVERVIEW:

Ensure accurate and timely submission of medical claims to insurance companies and government agencies, payment posting, statements and collection management, insurance denials and prior authorizations. Must be able to work independently and efficiently. The Medical Biller will work closely with the Chief Fiscal Officer to manage the billing submittal and corrections.

RESPONSIBILITIES: 

• Prepare and submit medical claims to insurance companies and government agencies.
• Verify insurance payment and patient payment posting.
• Knowledge of CPT codes
• Conduct medical coding reviews to ensure compliance and accuracy.
• Identify and resolve billing discrepancies.
• Preparing and submitting billing data and medical claims to insurance companies.
• Insurance verification
• Generating statements and posting payments
• Monitor the electronic data interchange portal daily to research, resolve, and resubmit the previous day's claims that were rejected.
• Following up on missed payments and resolving financial discrepancies.
• Review any claims denied by the insurance carrier and work to resolve and resubmit
• Research and resolve all underpayments and denials that are not coding-related.
• Report rejection trends and work to resolve the root cause of rejections.
• Comply with company policies and compliance requirements, and perform work in compliance with regulatory standards about billing, patient privacy, protection of electronic health information, etc.

QUALIFICATIONS:

• High school diploma or equivalent, plus two years’ experience in medical billing work. 
• Must possess Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
• Must possess positive customer service abilities. 
• Must have full knowledge of the work processor, Microsoft Office, Excel and experience with the Electronic Billing systems.

PHYSICAL REQUIREMENTS:

• Prolonged periods of standing and walking.
• Frequently required to sit, reach with hands and arms, and stoop, kneel, crouch, or crawl.
• Must be able to lift and/or move 25 pounds.