Insurance Billing Specialist

ESSENTIAL FUNCTIONS AND BASIC DUTIES

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

• N/A

Position-Specific Performance Expectations, Duties, and Responsibilities:

• Processes and submits health insurance claims to various insurance companies in a timely and accurate manner.
• Ensures claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS). Collaborates with the coding and clinical departments to resolve edits and denials.
• Maintains a working knowledge of Medicare and Medicaid as well as commercial payer guidelines and stays abreast of new policy changes.
• Verifies patient eligibility and coverage details before claim submission and reconciles coverage denials when necessary.
• Resolves claim edits both in the electronic medical record (EMR) and in the clearinghouse to prevent denials.
• Follows up with insurance companies regarding denied or underpaid claims and submits appeals when appropriate.
• Reviews insurance and patient credit balances and resolves them in a timely manner.
• Educates patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities.
• Documents all actions taken with an account in the electronic medical record (EMR).
• Performs other duties as assigned.

Organization-Specific Performance Expectations, Duties, and Responsibilities:

• Demonstrates full commitment to the CHOICE values of MRH and consistently represents the organization in a positive, professional manner.
• Establishes and maintains effective verbal and written communication, fostering positive working relationships with patients, staff, and vendors.
• Adheres to the MRH attire and dress code in accordance with organizational policies and procedures.
• Exhibits initiative and self-motivation; maintains a consistent level of productivity and manages time and responsibilities effectively.
• Completes all required annual education, training, in-services, and licensure/certification updates; actively participates in departmental and organizational meetings or reviews meeting minutes as required.
• Maintains strict patient confidentiality at all times.
• Reports to work punctually and completes assigned duties within established timeframes.
• Actively contributes to departmental and organization-wide performance improvement and continuous quality initiatives.
• Ensures compliance with all regulatory requirements, maintaining adherence to departmental, hospital, state, and federal standards and policies.
• Follows all infection control, safety, and risk management procedures to maintain a safe environment for patients, the public, and staff.

QUALIFICATIONS

• Must be at least 18 years of age (21 for positions requiring driving, with a valid driver’s license).
• Must be legally authorized to work in the United States.
• Must successfully pass a background check.
• Must successfully pass a pre-employment drug screen and breath alcohol test (if applicable).
• Must complete an Employee Health meeting prior to starting employment.