Billing Specialist II

Job Summary: The Medical Billing Specialist II is primarily responsible ensuring revenue cycle objectives are met by assisting with special projects, training, billing and resolution of denials.for the resolution of denied claims and developing strategies to optimize billable encounters.

Essential Functions:

• Responsible for all special projects assigned from leadership

• Provide training as needed related to billing processes

• Identify and resolve complex claims and billing issues. (including payer-rejected claims).

• Investigate payer- rejected claims to determine reason for denial.

• and work to obtain resolution.

• Determine strategies to reduce denials based on denial reasons, changing laws and practices.

• Prioritize and work HOLD an MGR HOLD buckets.

• Monitor claim rejections percentages and report denial percentages regularly.

• Prepare reports out of the EHR system as needed.

• Regularly interact and assist in training of the front desk staff concerning patient insurance eligibility.

• Support the revenue cycle by ensuring claims are dropped within 3 business days of service.

• Performs other duties as required.

Required Qualifications:

• Minimum of 5 years experience as a billing coordinator or specialist or similar position.
• Solid understanding of billing software and electronic medical records.
• Understanding of relevant laws and best practices as it relates to Medicare and Medicaid billing.
• Ability to problem solve and develop solutions.
• Great attention to detail and highly organized.
• Excellent communication and interpersonal skills.
• Understanding of HIPAA regulations and medical terminology

Requirements

• High school diploma required
• Minimum of one-year experience in bookkeeping/accounts payable.
• Experience with Excel required,  Athena preferred.

Physical and Mental Requirements:

• Position requires extended periods of sitting and standing including bending and reaching
• Handles stress in a positive manner
• Ability to be flexible and to multitask
• Demonstrated interest in working with an under-served population