A Billing Specialist assists in the overall financial success of the organization by providing specified services to recover monies owed to the physicians and/or facilities by Medicare, Medicaid, third-party payers, and patients for services rendered. Manages an assigned accounts receivable portfolio to ensure those monies are received or accounted for as well as completes a range of billing and accounts receivable tasks within and for the billing department. Performs related customer service, clerical and administrative tasks while following Standard Operating Procedures established for the billing department. Maintains adherence to company policies, local, state, and federal regulations and protects patient information.

Requirements

• Thorough working knowledge and understanding of physician and/or hospital billing and accounts receivables processes to include aggressively working an aging report each month.
• Familiar with HMO, PPO, Medicare, Medicaid and Worker's Compensation.
• Knowledge of ICD-9, CPT Coding, Modifiers and Coding Edits.
• Experience submitting claims as well as understands the process for handling appeals and denials with a successful overturn rate.
• Stay current with billing compliance to include Stark, Anti Kick Back, Privacy and Security laws.
• Ability to follow directions, adhere to Standard Operating Procedures and utilze reference material.
• Have good oral and written communication skills and remain committed to continually working to improve in this area.
• Technically proficient in Microsoft Word, Excel, e-mail, and computerized billing system.
• Ability to use normal office equipment, i.e. telephone, computer, calculator, copier, fax and postage meter.

Principal Duties and Responsibilities

• Performs eligibility verifications, obtains referrals and prior approval for treatment/payment.
• Contacts new patients regarding financial responsibility and makes payment arrangements.
• Registers patients and performs front end auditing for diagnosis consistency prior to charge entry.
• Enters accurately into the Billing Program all applicable ICD-9 and CPT codes from the Superbill, Intellicure Billing Report or Segment Sheet, for submission to the appropriate party for payment.
• Monitors outstanding collections by means of an aging report and contact insurance companies to follow-up on receivables. Refiles claims that are identifed as not on file, performs Telephone Reopenings or Reconsiderations, submits Corrected Claims, Timely filing appeals and Medical Necessity Appeals or adjustments as appropriate.
• Works rejected claims and correspondence, identifying the cause, correcting the errors and resubmitting the claim for payment.
• Analyzes denied claims correspondence, determining and performing the appropriate action to resolve the outstanding balance on the claim.
• Works diligently to keep new accounts receivable current.
• Handles insurance and patient inquiries providing excellent customer service, including timely response to telephone calls, e-mails, and other verbal or written correspondence.
• Work other correspondence to include Request for Medical Records.

This job description does not state or imply that the above are the only duties and responsibilities assigned to this position. This position requires performing other job-related duties as requested by management. All requirements are subject to possible modification to reasonably accommodate individuals with a disability.