Medical Billing Specialist in Lancaster, Pennsylvania at Schreiber Ctr For Pediatric Development

Status: Non-Exempt, Hourly

Shift: Part-time, 20-25 hrs/week

Department: Billing

Reports To: Accounting Manager

Job Family: Finance

Job Classification: 04

SUMMARY: The Medical Billing Specialist is a key position in the Revenue Cycle focusing on Denials withing the Revenue Cycle. They manage the claims process, including verification of insurance benefits, acquisition of authorizations, accurate/timely claim creation, follow-up and correspondence/inquiries with clients/providers/insurance companies. They manage the claims process, including verification of insurance benefits, acquisition of authorizations, accurate/timely claim creation, follow-up and correspondence/inquiries with clients/providers/insurance companies. This position will assure payments are recorded and reconciled in a timely manner to maximize cash flow/reimbursement, assist in the clarification and development of process improvements, and ensure compliance with department, Center and regulatory policies/procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned:

• Maintain knowledge of ICD-IO, CPT codes, medical terminology, medical billing, insurance reimbursement, and third-party regulations, including healthcare governing agency policies and procedures.
• Maintain/Improve knowledge of the Center's billing system.
• Maintains strict confidentiality; adheres to all HIPPA guidelines/regulations.
• Verify/input all new/updated demographic and authorization information into the medical billing software; Coordinate this process with the front desk and intake as needed.
• Maintain individual files to include up to date requirements needed to successfully obtain authorizations and submit clean claims.
• Review all payments for accuracy and compliance with contract discounts.
• Research and appeal all denied claims; Submit medical records requests per the insurance EOBs; Initiate peer-to-peer reviews as needed.
• Follow up on unpaid claims within the standard billing cycle timeframe, resubmit claims as needed and maintain adequate notes on the follow-up process in the billing system.
• Track number of visits for patients with a limited number of insurance covered therapy visits and notify families when they are approaching their insurance benefit maximum.
• Answer all patient and/or insurance questions.
• Coordinate with fellow co-workers in a positive, cooperative and professional manner to assist with all claim resolutions, patient questions and testing of new CPT codes.
• Responsible for training and back-up for all medical billing positions.

SUPERVISORY RESPONSIBILITIES: Directly supervises no employees.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE: High School diploma required. Medical Billing and Coding Certificate preferred. Associates degree (A.A.) or certificate from a college or technical school and/or 5 years related experience preferred; or equivalent combination of education and experience.

LANGUAGE SKILLS: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to extract data from conversations and documents. Ability to write routine reports and correspondence.

MATHEMATICAL SKILLS: Ability to calculate figures and amounts such as discounts, interest, commissions and percentages. Ability to interpret accounts and records and develop spreadsheets and reports. Ability to perform basic bookkeeping and compile statistics.

REASONING ABILITY: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to maintain confidentiality. Adheres to all HIPAA guidelines/regulations.

CERTIFICATES, LICENSES, REGISTRATIONS, CLEARANCES: Courses in billing and coding procedures or accounting preferred, Previous medical billing experience preferred. Up-to-date child abuse clearances (within one year or completed and received before state date) including FBI Fingerprinting, Pennsylvania State Police Criminal Background Check, Pennsylvania Department of Human Services' Child Abuse, and National Sex Offender Registry.

OTHER SKILLS AND ABILITIES: Ability to use a computer, medical billing software, adding machine, calculator, copier, typewriter, and various office equipment. Experience with Microsoft Office, especially Excel, required. Experience with Rain Tree, Waystar and PROMISe preferred. Data entry, organization, thoroughness, confidentiality, and attention to detail skills required.

PHYSICAL DEMANDS: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.