Billing Specialist

Essential Duties and Responsibilities :

Obtain referrals and pre / post-authorizations for ambulance services

Check eligibility and benefits verification

Review insurance and facility claims for accuracy and completeness

Prepare, review, and transmit claims using billing software, clearinghouse, and payer websites

Following up on unpaid claims within standard billing cycle timeframe

Reviewing underpaid claims for appropriate escalation steps to ensure appropriate reimbursement for services

Calling insurance companies regarding any payment discrepancies

Identifying and billing secondary or tertiary insurance

Processing incoming mail and taking appropriate follow up actions to resolve accounts

Researching and appealing denied claims

Answering all patient or insurance telephone inquiries

Contacting the patient to escalate issues with the insurance companies

Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Performing other duties as assigned.

Qualifications : Proficient with a PC

Knowledge of Health Insurance Portability and Accountability Act (HIPAA)

Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes)

Knowledge of medical terminology

Knowledge of Medical Billing

Knowledge of insurance guidelines including HMO / PPO, Medicare, Medicaid, and commercial payers

Customer service skills for interacting with patients regarding medical claims and payments, including

communicating with patients and family members of diverse ages and backgrounds.

Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections

Ability to work independently and with a group

Working knowledge of MS Word, Excel

Ability to maintain effective working relationships.

Thorough knowledge of office practices

Ability to type at least 35 words per minute.

Proficiency using 10 key

Education and Experience Requirements :

High School Diploma or GED

Minimum of one year revenue cycle management experience or related experience

Physical Requirements :

Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other

federal, state and local standards, including meeting qualitative and / or quantitative productivity standards.

Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local

standards.

The employee may occasionally be required to lift and / or move up to 20 pounds

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision,

depth perception, and the ability to adjust focus.

Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and

other physical exertion.

Must be able to talk, listen and speak clearly on telephone.

Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a

motor vehicle.

Travel Time : Negligible