Medical Billing specialist

Description:

JOB DESCRIPTION:

The Medical Billing Specialist is responsible for the billing, collections, follow up and appeals of insurance claims and patient accounts. Essential to this position is the ability to manage all insurance follow up for maximum insurance reimbursement. To include outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working denials and resolving unpaid claims.

Requirements:

JOB RESPONSIBILITIES/DUTIES:

· Claim submission

· Work assigned claim volume timely and efficiently with corporate timeframes

· Actively follow-up on outstanding patient account balances, and all insurance claims using the A/R aged reports, including resolution of any billing errors.

· Research, appeal, and resolve unpaid insurance claims.

· Respond to correspondence from insurance carriers.

· Collecting and posting payments in patient accounts

· Contacting customers regarding outstanding balances

· Resolving partial payment or denials from insurance companies

· Insurance verification

· Reviewing explanation of benefits and correspondence

· Follow up on all returned claims, correspondence denials, account reconciliations and rebills.

· Monitor and reconcile reimbursement from managed care networks-and insurance-carriers ensuring correct reimbursement with contracted rates.

· Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursements to providers, managers, and staff.

· Performs other job-related duties as assigned.

· Follow all process and procedures as set by leadership.

· Understanding and staying informed of the changes with procedures, billing guidelines, and laws for specific insurance carries or payers.

· Frequent speaking, listening using a headset, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer.

· While performing duties of this job, the employee is frequently required to stand, walk and sit.

QUALIFICATIONS:

· Athena experience is a plus

· Minimum 5+ Years of experience with insurance follow up and insurance collections.

· Minimum 3+ years of experience with Ambulatory Surgery Center verification of benefits, billing, and/or collections.

· Knowledge of both In Network and Out of Network Facility and Physician Claims.

· Strong communications skills in both oral and written.

· Positive attitude, Team player and ability to work independently.

· Experience in reading, analyzing and interpreting EOB’s is a must.

· Prior experience working with commercial payers such as UHC, Cigna, Aetna, BCBS, Work Comp and Third Party is a plus.

· Proven experience administering appeals in a high-volume claim’s environment.

· Proven experience in a production-based environment with concentration on meeting production standards.

· Ability to have clearly communicate claim follow and appeals with insurances company representatives.

· Demonstrates excellent problem-solving skills and negotiating skills.

· Familiarity with computer and Windows PC applications such as Excel and Word, which includes the ability to learn new computer systems applications.

Texas Regional Physicians does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, national origin, marital status, citizenship status, physical or mental disability or veteran status.

The above job description is intended to describe the general content of and requirements of the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

The statements in this job description are intended to describe the essential nature and level of work performed by the employee assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties & skills required of this position so classified.

Job Type: Full-time

Pay: $18.00 - $20.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule: Monday to Friday

Work Location: one to two locations