Medical Billing Specialist

Position Summary

This position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers.  This position functions as a liaison between patients, third-party payers, physicians, clinics, and HCHN staff regarding billing.  Works under the direction of the Director of Revenue Cycle Management or designee, who assigns diverse billing duties and responsibilities.

Duties & Responsibilities

• Able to perform accounts receivable collection activities timely and accurately, including prioritizing subtasks.
• Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days.
• Accurately post all insurance payments by line item.
• Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely*
• Collects on outstanding claims from third party payers according to department benchmarks.
• Works on special billing projects as assigned by the Billing Supervisor in conjunction with other billing responsibilities.
• Contacts appropriate departments and eligibility systems to obtain necessary information for billing purposes.
• Responds efficiently and accurately to denials received. Ensures necessary information is obtained and resubmitted as quickly as possible.
• Documents the practice management system to reflect current billing status of each patient account to ensure audit trail of all account activity.
• Accurately documents reasons for denials that cannot be re-billed, and communicates such information to Billing Supervisor for follow-up.
• Processes patient, payer, and employee interactions within the guidelines set for the department.
• Responds professionally and timely to patient calls and third party payer calls.
• Meets professional behavior expectations as evidenced by compliance with the following standards:

• Meets all attendance and punctuality requirements to ensure proper coverage and quality service
• Professional and appropriate dress as required by the position
• Demonstrates an ability to resolve interpersonal and professional conflicts appropriately
• Ability to formulate decisions and make judgments that are demanding and interpretative
• Keeps all matters related to the organization confidential in compliance with confidentiality policy
• Performs other duties as assigned related to revenue cycle management.

Education and Experience

Required

• High school diploma
• Minimum of four (4) years’ experience working Accounts Receivables
• Must know medical terminology 
• Must have knowledge of outpatient billing procedure for third party payers, medical terminology, CPT coding, ICD9 coding, and completing UB92 and HCFA claim forms
• Computer experience is essential, including, but not limited to: practice management software, word   processing and spreadsheet applications.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.

Preferred

• CCS or CPC certification
• Some college or other technical school training