POSITION OVERVIEW

The Billing Specialist is responsible for Accounts Receivable Management, working all denied claims, seeks full payment from the specific insurance carriers they are responsible for. In addition, prepares appeals for incomplete or non-payments with proper documentation along with researching, analyzing and reconciling billing and reimbursement practices.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Works in our practice management systems Collection Module and/or Aging Reports to identify aged/denied claims and pull necessary information to investigate claims.
• Actively follow-up on outstanding claim balances by checking claims on the carrier’s website or by calling the insurance companies and other payers as needed.
• Prepare appeals paperwork for all payers by gathering supporting documentation as needed.
• Recognize and appropriately report problems or negative patterns in support of maximization of billing and collections.
• Work claims hitting edits in TriZetto Provider Solutions (Clearinghouse).
• Avoid and/or resolve errors which may lead to undo write-offs or insurance rejections.
• Identify accounts requiring charge or payment corrections.
• Credentialing new physicians, nurse practitioners, audiologists and SLP’s for the insurance carriers they are responsible for.
• Run collection reports per physician call to collection outstanding balance prior to next visit or communicate to the scheduler to cancel appointment.
• Respond to emails from Patient Services team regarding patients in collections then calling the patient to collect outstanding balance.
• Phone work as scheduled to include incoming calls requesting account information and making outgoing calls for account investigation.
• Review weekly statements sending letters or emails to patients to collect payment prior to sending to collections.
• Provide backup phone coverage and other office responsibilities as a member of the Billing Team.
• Handle other duties and special projects as assigned.

EDUCATION, EXPERIENCE & KNOWLEDGE REQUIREMENTS

Education

• High School Diploma or equivalent

Experience

• Minimum 3-5 years medical billing experience.

Knowledge & Skills

• Proficiency in using computers and ability to learn various software.
• Superior organizational and problem-solving skills, and attention to detail
• Familiarity with medical billing systems, ICD-10, CPT, medical coding, and basic medical terminology.
• Ability to work well in a team environment.
• Strong communication (verbal and written) skills.