Summit Healthcare Solutions:

Specializes in developing and implementing strategies to ensure client success. The organization provides healthcare consulting, occupational healthcare, workforce solutions, onsite medical support and healthcare education. Summit Healthcare Solutions supports the health and wellness of its workforce by empowering employees to be active in the decision making process. Summit Healthcare solutions cultivates an environment that promotes respect, communication, and professional growth. Let Summit Healthcare Solutions transform the way you think about your professional career.

Scope:

We are seeking a motivated and skilled medical billing specialist to join our dynamic team of professionals. The medical billing specialist plays an essential role in the medical office by reviewing, validating, and billing clinical services rendered.

The medical billing specialist is responsible for managing and processing patient billing information, ensuring accuracy in billing procedures, and handling insurance claims. This role involves working closely with healthcare providers, patients, and insurance companies to ensure that all billing-related activities are handled efficiently and accurately.

The ideal candidate will have experience in medical billing, have excellent interpersonal skills, is results-driven, self-motivated, and have a deep understanding of medical billing and coding. This position reports to the medical provider within the medical office.

All services shall be provided in accordance with established standards, principles, and ethics of the profession, applicable professional specialty organizations, and the high-quality standard for which Summit Healthcare Solutions is recognized.

Responsibilities:

· Collaborate with team members to understand specific healthcare facility requirements for medical billing and medical office specific needs.

· Self-motivated to gain in-depth knowledge on industry trends, challenges, and requirements for effective healthcare billing strategies.

· Accurately enter and code patient services into the billing system.

· Ensure compliance with medical coding guidelines (ICD-10, CPT, HCPCS).

· Review patient bills for accuracy and completeness and obtain missing information.

· Determines appropriate charges based on services provided.

· Reviews patient accounts to ensure accuracy and completeness of claims billing for maximum reimbursement.

· Reviews explanations of benefits from third party payers to determine if payment was made correctly and if denials can be re-billed.

· Prepare and submit claims to various insurance companies electronically or via paper.

· Monitor and follow up on outstanding claims to ensure timely payment.

· Handle claim rejections and denials by researching and correcting billing errors, and resubmitting claims.

· Coordinate with insurance companies to resolve any discrepancies or issues.

· Analyzes and maintains reports to ensure timely submission of claims.

· Process patient statements and manage account receivables.

· Assist patients with billing inquiries and provide detailed explanations of charges.

· Set up payment plans for patients as needed and follow up on overdue accounts.

· Apply payments to patient accounts and balance daily transactions.

· Identifies problem accounts requiring further work.

· Provides information to insurance carriers or patients regarding patient accounts.

· Ensure compliance with healthcare regulations, including HIPAA and other applicable laws.

· Maintain patient confidentiality and protect their sensitive information.

· Assists patients with billing problems.

· Work closely with medical staff to verify and obtain necessary information for billing.

· Notifies supervisor of ongoing problems.

· Generate and analyze billing reports to identify trends and areas for improvement.

· Provide regular updates to management on billing activities and account statuses.

· Maintains files on all documentation such as charge slips, Explanations of Benefits, and client or patient information.

· Prepares and distributes reports.

· Refers accounts to collectors in accordance with policy.

· Performs other related duties as assigned or requested.

Qualifications:

· Education: High School Diploma or equivalent.

· Experience:

· Medical billing: Two (2) years required

· CPT Coding: One (1) year

· ICD-10 codes: Two (2) years

Preferred Qualifications:

· CPT Coding: Two (2) years preferred

· ICD-10 codes: Three (3) years

· Certified Professional Coder (CPC) certification is highly preferred

· Certified Coding Specialist (CCS) certification is highly preferred

· Certified Medical Coder (CMC) certification is highly preferred

· Experience with Athena health platform

Skills and Competencies:

· Must have excellent oral and written communication skills, strong analytical and problem-solving skills, the ability to thrive and multi-task in a dynamic, fast-paced environment.

· Proficiency with computer and common office equipment, as well as with MS Office products.

· Strong understanding of medical terminology, billing codes, and insurance processes.

· Strong analytical and problem-solving skills.

· Effective communication and customer service skills.

· Ability to handle sensitive and confidential information with discretion.

· Knowledge of regulatory requirements related to medical billing and coding.

Physical Requirements:

Work is normally performed in a typical interior/office work environment.

Work involves sitting for prolonged periods of time.

Visual acuity for reviewing detailed billing information.

Manual dexterity for operating a computer and other office equipment.

May require bending, stooping, and lifting up to 10 lbs.

Equal Opportunity Employer

Summit Healthcare Solutions is proud to be an Equal Opportunity Employer (EOE). Employment selection is determined without regard to race, color, sex, sexual orientation, gender identity, national origin, religion, age, genetic information, veteran status, disability, and any other statuses protected by law.