The Medical Billing Specialist a key associate at Hope Network whose primary responsibilities include: Provides billing and collection services. This position needs a working knowledge and experience billing Auto No-fault, BCBS, Commercial, Medicare/Medicaid, Workers Compensation, Private payers, and Community Mental Health payers.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
This is not intended to be an exhaustive listing of job functions. This job description in no way states or implies that these are the only duties to be performed by this employee. The employee is required to follow any other instructions and to perform any other duties as assigned.
1. Regular and predictable attendance is an essential requirement of this position.
2. Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
3. Following up on unpaid claims within payer/funder billing cycle timeframe.
4. Review explanation of benefits for accuracy of payments,adjustments and patient responsibility.
5. Follow up with insurance companies/funding sources regarding any discrepancy in payments if necessary.
6. Identifying and billing secondary or tertiary insurances.
7. Researching and appealing denied claims.
8. Write up account adjustments for approval.
9. Ensure proper documentation is sent with each claim when required.
10. Utilize specific knowledge regarding billing and reimbursement guidelines to expedite payment for services.
11. Provide assistance to staff from all locations with billing and collections inquiries.
12. Utilize systems and procedures to organize the billing office for maximum efficiencies.
13. Works all outstanding accounts over 60 days old for collectability.
14. Complete all other designated projects relevant to position description.
15. Escalate any billing, collection or system related issues with payer/funders to leadership.
16. Attend regular department/payer meetings.
17. Other duties, as required or assigned.
Educational / Talent Requirements:
1. High school diploma or equivalent is required.
2. Relevant certification preferred (CCS-P, CPC, CPB) or Associate’s degree in related area of study.
3. Demonstrated ability to communicate in both written and verbal format to meet position responsibilities.
4. Demonstrated ability to use word processing, spreadsheet and computerized billing programs including Word/Excel.
5. Data entry skills equivalent to typing skills at 40 words per minute.
6. Familiarity with other office equipment such as calculators, fax and photocopying equipment.
7. Ability to plan, organize and prioritize work on a daily basis.
8. Excellent written and verbal communication skills required.
9. Excellent organizational and interpersonal skills.
Work Experience Requirements:
1. 2 years relevant medical billing and collection experience.
2. Experience in collections, accounts receivable, data processing and business office procedures.
3. Demonstrated knowledge of medical billing and reimbursement.
4. Demonstrated knowledge in the accounts receivable monitoring process (aging of accounts 0-30, 30-60, 60-90 days).
5. Ability to interact effectively with individuals, employees, referral sources, vendors and other designated individuals.
6. Ability to travel to other Hope Network sites when needed and requested; valid driver’s license with acceptable driving record.