Medical Billing Specialist

The Medical Billing Specialist will be responsible for follow up on all outstanding accounts receivable (AR); this includes both commercial and government insurance payers, self-pay accounts, and resolution of denials. The Medical Billing Specialist conducts follow up by way of phone calls, online processing, and written correspondence, and must be able to communicate effectively with payer representatives to support denial resolutions. The Medical Billing Specialist will assist with inquiry calls and provide support to both internal and external customers. The Medical Billing Specialist will have an extensive knowledge of explanation of benefits, electronic remittance advice and insurance terminology.

1. Review and interpret insurance explanation of benefits (EOB) documents for accuracy and compliance with contracts.
2. Follow up with the insurance company on unpaid or rejected claims and resolve the issue either by appeals process or re-submission of the claim.
3. Appeal denials with the appropriate documentation per the medical insurance carrier’s requirements, and write the appeal letter when necessary.
4. Serves as liaison between the providers of health care services, the patient, or other responsible persons, and revenue sources, to ensure the correctness of charges, a current record of all transactions, and account resolution.
5. Maintains active communications with patient and third-party carriers until account is paid or referred to other appropriate agency for further collection activity.

6. You will prepare adjustment requests for insurance and patient refunds and write-offs for approval and processing.
7. Preparation of Accounts to collections with Billing Supervisor’s review and approval.
8. Other duties as assigned.

Education:

• High School Diploma or GED is required

Experience:

• Minimum 3 years in medical billing/collections and customer service experience.
• Position requires an advanced knowledge of public and private insurance billing.

Skills & Abilities:

• Knowledge of insurance guidelines. Including Federal and State Agencies.
• Knowledge of coordination of benefits requirements and process
• Familiarity with CPT and ICD-10 coding
• Effective communication abilities for phone contacts
• Knowledge of insurance rejections/denial processing
• Customer service skills for interacting with patientsAbility to work well in a team environment and be flexible in problem solving environment
• Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)