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