Medical Billing Specialist

Billing Specialist

The medical billing specialist is responsible for ensuring accurate billing, timely submission of electronic and / or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and collection specialist must possess critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments base on payer contracts or government regulations. In addition, the medical billing and collection specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims to Insurances nationwide.

Accountabilities :

Responsible for charge and payment entry within Electronic Health Record. Coordinates and clarifies with clients / customers, when necessary, on information that seems incomplete or is lacking for proper account / claim adjudication.

Responsible for correcting, completing, and processing claims for all payer codes.

Analyze and interpret the claims are accurately sent to insurance companies.

Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and health insurance companies on unpaid insurance accounts identified through aging reports.

Able to identify and appeal claims if needed and or ability to process appeals online or via paper submission; Assist with billing audit related information.

Attends customer meetings / workshops / implementations when needed.

Ability to navigate commercial / customer payment platforms and or portals.

Communicate daily with internal and external customers via phone calls and written communications.

Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Team Lead and / or Supervisor.

Research, record findings, and communicate effectively with Manager to achieve optimum performance.

Pursue and participate in education to remain current with changes in the Healthcare industry.

Maintain HIPPA / PHI requirements.

Promote effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives.

Demonstrate respect to all fellow employees to ensure a professional, responsible and courteous environment.

Other duties and projects as assigned by management.

Requirements :

Minimum of one year of related experience in clinical, medical, or medical services environment.

Previous experience in a medical office setting and / or experience with an Electronic Medical Record a plus.

Customer service driven.

Understanding of medical terminology and insurance laws / guidelines

Excellent organization and time management skills along with excellent oral and written communication skills.

Strong team player.

Ability to learn quickly, build and maintain long term relationships and work with minimal supervision.

Strong written and verbal communication skills; strong analytical, organizational and time management skills required. The ideal candidate will have billing software experience or have used similar billing systems.

Language Skills :

Ability to read, analyze, and interpret general health and social services guidelines, technical procedures or governmental regulations. Ability to write reports, health correspondence and procedure manuals. Ability to effectively present information and respond to questions from groups or patients, center staff, and the general public.

Mathematical Skills :

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions.

Customer Relationships :

Follow through with customer inquiries, requests and complaints. Forward difficult and non-routine inquiries or requests to appropriate level for resolution.

Work Environment :

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is largely a desk-bound role with typical office noise; however, frequent movement throughout the office is required. Frequent sitting, standing, and walking are daily activities. Some bending and filing may be required (

Position Type :

This is a full-time, non-exempt-level position based at Corporate headquarters.

Equal Opportunity Statement :

At GA Foods, we are deeply committed to the principles of equal employment opportunity. It is our policy that all employment decisions are made without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetics, disability, veteran status, or any other characteristic protected by local, state, or federal law.

We base all employment decisions on merit, qualifications to perform the essential job functions (with or without reasonable accommodations), and business needs.

GA Foods also provides affirmative action in employment for qualified individuals with disabilities and protected veterans, in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans' Readjustment Assistance Act.

GA Food Services of Pinellas County, LLC (GA Foods) is proud to be a Drug-Free, Smoke-Free Workplace and an Equal Employment Opportunity Employer.

Equal employment opportunity, including veterans and individuals with disabilities.

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