Medical Billing Specialist

Essential functions
Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
• Processes billing to patients and third party insurance companies.
• Researches and responds by telephone and / or in writing to patient inquiries regarding billing issues and problems.
• Responsible for tasks requiring data analysis, in-depth evaluation, and sound judgment
• Monitors submitted claims; follows up on unpaid claims, and initiates dialogue with insurance companies.
• Ensure the patient’s medical information is accurate and updated
• Evaluates patient’s financial status and establishes budget payment plans.
• Reviews accounts for possible assignment to collections
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Assist with Sliding Fee Scale and cash discounts
Competencies
• Proficient in computers and relevant software applications and practice management technology
• Possession of strong problem-solving skills and sound judgment
• Ensure accuracy/efficiency in medical billing, patient account management, timely collections, and patient eligibility
• Identify denials resulting from ineffective office practices and offering solutions and suggestions
• Identify denial trends by payer and discuss their trends with management

Required education and experience
• High school diploma or equivalent
• Minimum of 2 years previous experience as a medical biller or in a related healthcare administrative position
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid and other payer requirements and systems
• Familiarity with CPT and ICD10
• Maintaining patient confidentiality as per the health Insurance Portability and Accountability Act of 1996 (HIPAA)
• Knowledge of medical terminology likely to be encountered in medical claims
Preferred education and experience
• Associate’s / Bachelor’s Degree
• Knowledge of business and accounting processes
• Experience with Athenanet EMR
• Language proficiency in Spanish or Arabic desirable.
• Certified Medical Biller/Coder preferred