Essential Functions:
Medical Billing:
- The specialist is responsible for the timely submission of professional medical claims to various payors.
- Prepare, review, and transmit claims for electronic and/or paper claim submission from the PM system.
- Responsible for resolving claim edits and clearinghouse rejections via the PM system.
- Responsible for processing all secondary claims via electronic and/or paper claim submission.
- Responsible for submitting claims with required documents, per payor guidelines or as requested (i.e., medical records).
- Review patient statements for accuracy and completeness prior to billing.
- Maintain a current understanding of local coverage determinations, payor and coding guidelines to ensure claims are consistently billed properly.
- Perform charge reconciliation from the daily appointment schedule.
- Perform posting of charges, electronic and/or manual to the PM system.
- Keep abreast with medical coding updates and educate team members of changes in a timely manner.
- The specialist will maintain confidentiality and is knowledgeable of AMA CPT, HCPCS, and ICD codes and HIPPA guidelines.
- Ensure patient and insurance demographics are accurate.
- Enter and make the appropriate changes in the EMR/PM system(s) regarding insurance and eligibility, and insurance information, as needed.
- Respond to email and phone calls related to billing and claim submissions.
- Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
- Ensure appropriate authorization or referral numbers are on the claim prior to submission.
- Performs job duties with oversight.
- Other duties as assigned.
Qualifications:
- High School diploma or equivalent required
- 3 years of experience in medical billing strongly preferred
- 3 years of experience in a specialty group practice preferred
- Comfortable navigating across various computer systems to locate critical information.
- Medical billing and coding certification preferred.
- Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
- Experience with a CMS-1500 claim form.
- Experience working with clearinghouses for the purpose of claim submissions.
Job Type: Full-time
Pay: $24.00 - $27.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Work Location: In person