Medical Billing Specialist

JOB SUMMARY:

The Medical Billing Specialist for Nurse Practitioners is responsible for processing and mailing/transmitting claims, tracking claims, monitoring authorization and eligibility of payor benefits, managing the collections process and posting cash receipts.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Extract and verify billing information from medical records
• Ensuring collection of past due balances; follow up as needed
• Ensure all patient demographic and insurance is accurate prior to submitting claims to insurance companies
• Answer patient account inquiries; assists establish alternative payment plans when necessary
• Maintain patient account records; settle third party payer issues as required
• Receive and review Daily Reconciliation Review (DAR) document for accuracy; enter charges into Practice Management System (PMS)
• Prepare and review patient statements prior to release through PMS
• Ensure timely filing of all Medicare, Medicaid, and third-party insurance claims
• Balance daily charges; reconcile with reports within PMS
• Collaborate with revenue cycle manager and payers on denials/rejections
• Work closely with practice representatives to ensure proper insurance verifications and authorizations are obtained
• Other duties as assigned

JOB REQUIREMENTS:

• Comply with applicable legal requirements, standards, policies and procedures including but not limited those within the Corporate Compliance Program, Corporate Code of Conduct, HIPAA, and Federal False Claims Act
• Report concerns and suspected incidences of non-compliance immediately to the Chief Compliance Officer
• Communicate professionally with patients and guarantors regarding balances or account information
• Participate in required orientation and training programs
• Cooperate with monitoring and audit functions and investigations
• Participate in process improvement responsibilities
• Meet productivity goals
• Successful completion of required training
• Handle multiple priorities effectively

REQUIRED SKILLS:

• Problem solving skills to manage a variety of concrete variables
• Effective verbal and written communication skills
• Ability to interpret instruction presented in variety of situations
• Strong organizational skills; ability to manage multiple projects simultaneously
• Proficiency with Microsoft Word, Excel, PowerPoint, and Internet Explorer
• Ten key speed and accuracy

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.