JOB SUMMARY
The Billing Specialist is responsible for all aspects of billing inpatient and outpatient claims. The Billing Specialist, a key position in the Revenue Cycle, manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues.
Required Skills
ESSENTIAL JOB DUTIES AND FUNCTIONS
- Prepares and submits clean claims to third party payers either electronically or by paper.
- Follows billing guidelines and legal requirements to ensure compliance with federal and state regulations.
- Respond to account inquiries from patients, payers, providers, and/or other staff as requested.
- Identifies and resolves patient/insurance billing issues.
- Work closely with team members regarding claim appeals, denials, resolution, and education.
- Performs and monitors all steps in the billing processes to ensure maximum reimbursement from patients, government and commercial payers as well as from special billing arrangements.
- Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Updates business office staff, clinics, residents, and faculty of changes as appropriate.
- Responsible for ensuring all new residents and providers are oriented to coding, billing, and documentation compliance.
- Responsible for the continuing coding, billing, and documentation education for all providers and residents.
- Understands the considerations of coding in Value Based payment contracts.
- Responsible for reviewing and implementing changes from payer bulletins.
- Use online healthcare databases and other resources for verification and claim status.
- Deliver the highest quality service to internal and external customers.
- Assist other members of the team with projects as needed.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Other duties as assigned by management.
Required Experience
QUALIFICATIONS
- High School Diploma/GED with minimum 3 years billing experience.
- Must have strong knowledge of all guidelines for ICD-10, CPT/HCPCS codes, medical terminology, and billing processes.
- Knowledge of Medical Billing/EHR (Electronic Health Records) systems preferably Medent and Microsoft Office.
- Knowledge of EOBs, EFTs and ERAs.
- Must be focused, self-directed, organized, and have demonstrated problem-solving abilities.
- Accurate and precise attention to detail.
- Excellent verbal and written communication skills.
- Able to work both independently and as part of a team.
- Must possess team leadership skills and have a positive disposition.
PREFERRED QUALIFICATIONS
- Certified Biller
- FQHC Billing