Billing Specialist

Job Description

POSITION SUMMARY

The Billing Specialist is responsible for FCHC’s third party medical claims processing. Medical claims are prepared and submitted to Medicaid, Medicare, and private insurance companies. This position will handle questions, complaints, or problems from insurance companies, Medicaid offices and their associated Managed Care Plans, Medicare regions and their associated Health Maintenance Organizations, and families regarding insurance payments. Research, resolves, and resubmits denied claims and takes timely and routine action to collect unpaid claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The Billing Specialist job duties also include, but are not limited to:

Claim Submission:

• Create and process medical claims

• Verify compliance of all medical claims

• Maintain constant communication with insurance carriers to ensure a clear and concise claim process for claims to be processed quickly and efficiently.

• Issue Explanation of Bill to patients and interpret balances in which the patient is responsible for payment

• Accurately documents patient accounts of all actions taken.

• Educates clinic management and staff regarding changes to insurance and regulatory requirements.

• Actively participates in practice management meetings.

Completes additional projects and duties as assigned. •

Job duties are subject to change based on company needs

Claim Follow-up:

• Research and resolve rejected, incorrectly paid, and denied claims within an established time frame.

• Researches and resolves unpaid accounts receivable and makes any corrections in practice management system necessary to ensure maximum reimbursement for Family Christian Health Center services.

• Resubmits claim forms as appropriate.

• Professionally responds to all billing-related inquiries from patients, staff, and payors in a timely manner.

• Utilizes available resources to identify reasons for payment discrepancies.

Review denial report and correct claims and resubmit to insurance.

• Verify and update additional billing information and resubmit claims as requested by customer service, collectors or payers.

• Assists in resolving denied claims within framework of payer specifications.

• Tracks denial data and reports trends to reduce future denials.

• Assists with monitoring claim status follow-up.

• Remains current on all changes in legislative regulations that affect the reimbursement area.

• Review and correct failed claims report daily.

Administrative & Miscellaneous:

• Assist with external and/or internal audits as requested.

• Maintain current knowledge of government regulations pertaining to billing and collection for Medicare/Medicaid.

• Educates clinic management and staff regarding changes to insurance and regulatory requirements.

• Establishes and maintains a professional relationship with all FCHC staff in order to resolve problems and increase knowledge of account management.

• Completes additional projects and duties as assigned.

• Job duties are subject to change based on company needs

• Bring any system issues to the Billing Supervisor’s attention immediately.

• Use Excel and/or Word to prepare and maintain reports

• Provide excellent customer service while maximizing all duties.

• Other duties assigned.

EDUCATION, TRAINING AND EXPERIENCE

Minimum Qualifications:

• Certified Professional Biller preferred.

• Associate degree preferred.

• 5 years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.

• 5 years of experience in working with a medical office/hospital accounts receivable system.

• Extensive knowledge of insurance payor reimbursement, collection practices, and accounts receivable follow-up.

• Basic computer skills, including Microsoft Windows programs.

• Good keyboard skills with high accuracy rate.

• Knowledge of ICD-10, CPT and HCPCS coding.

• Ability to communicate effectively in written and spoken English.

Demonstrates overall knowledge of claims processing for various insurances both private and governed.

• Demonstrates effective communication and interpersonal skills with a diverse population.

• Demonstrates the ability to carry out assignments independently, work from procedures, and exercise good judgment.

• Demonstrates the ability to maintain the confidentiality of all records.

• Demonstrates knowledge of Medicare, Medicaid, and third-party coding requirements.

Full-time