Medical Billing Specialist

Department: Billing

Position:  Medical Billing Specialist

Employee Category:  Non-Exempt

Reporting Relationship: Manager of Revenue Cycle Management

Character First Qualities:

• Decisiveness- The ability to recognize key factors and finalize difficult decisions.
• Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice.
• Flexibility- Willingness to change plans or ideas without getting upset.
• Patience- Accepting a difficult situation without giving a deadline to remove it.
• Tolerance- Accepting others at different levels of maturity.

Summary of Duties and Responsibilities:

The Medical Billing Specialist is responsible for reviewing daily charges and adjustments entered for accuracy, filing third-party claims, self-pay patient billing, and answering billing questions from patients and staff.

Primary Duties and Responsibilities: 

1. Reviews assigned claims daily to ensure accuracy prior to claim submission.
2. Reviews documentation on self-pay claims to ensure that the appropriate discount is applied.
3. Makes billing corrections and adjustments to claims as appropriate to ensure prompt payment and accuracy of balance.
4. Validates the correct payer for claim as well as verifies patient eligibility when in question.
5. Contacts patients for missing information or clarification of documentation.
6. Requests documentation and/or information required to process claims; scans and uploads documentation and information to patient accounts as applicable.
7. Submits claims to clearinghouse daily.
8. Processes secondary and tertiary claims accurately and timely to ensure payment.
9. Coordinates with the Claims Resolution Specialists to assist in investigating denied claims and credit balances.
10. Completes rejection and rebill requests.
11. Follows up on pending claims and work to resolution.
12. Assists with patient phone calls regarding balances and benefits; advises patients of deductibles and co-payment status.
13. Assists patients with payment arrangements by coordinating with a Collection Specialist. Issues individual statements when necessary on patient accounts.
14. Assists the front staff with billing and eligibility related questions.
15. Keeps abreast of the variety of programs offered at each site and applies benefits correctly to patient charges.
16. Produces itemized billing requested by law firms or other agencies.
17. Processes DLO invoices monthly and sends all requested information from accounts.
18. Creates daily deposit slips on self-pay and private pay accounts.
19. Collects credit card payments from patients and posts to respective accounts.
20. Keeps current with dental, behavior health, and vision claims and processes.
21. Meets established daily, weekly, monthly, and annual deadlines.
22. Upholds Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information.
23. Follows written and verbal instructions from the Manager of Revenue Cycle Management.
24. Exhibits professionalism in communication with patients, clients, insurance companies and co-workers.
25. Participates in special projects.
26. Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable.  Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.
27. Embodies the strength of personal character.  Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment.  Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.
28. Performs other duties as assigned.

Essential Functions:

1. Must be able to lift 25 pounds.
2. Must be able to sit for extended periods of time.
3. Must have excellent concentration ability.

Requirements, Special Skills or Knowledge: 

1. High school diploma or GED.
2. Experience communicating with patients, management, front office, and providers to resolve claim or account issues.
3. Mastery of critical thinking, analytics, problem-solving, and sound decision-making skills.
4. Experience interacting and communicating effectively with individuals at various levels both inside and outside the organization, often in sensitive situations.
5. Proficiency with Microsoft Office and practice management software systems.
6. Experience assisting and supporting others in a professional and respectful manner.

Preferred Requirements, Special Skills or Knowledge: 

1. Bilingual (English/Spanish).
2. Work experience related to the medical field preferred in a Family Practice Setting.
3. Experience filing third party claims and reports in a timely manner.
4. Basic knowledge of medical terminology and protocols.
5. Basic knowledge of coding and anatomy.