Medical Billing Specialist II

Medical Billing Specialist II

Position Summary

The Medical Billing Specialist is responsible for taking all steps necessary to achieve complete account reconciliation.

Education

High School Diploma or equivalent - Preferred

Experience

2 Years medical billing experience - Required

License & Certification

None Required

Core Job Functions

• Possesses and applies a thorough knowledge of the practice management billing systems and the ability to apply the knowledge to all aspects of the patient account including insurance, billing and collection.
• Possesses and applies knowledge of CPT and ICD9 coding usage.
• Obtains all necessary information for completing the billing process, including charge information from the physician.
• Generates and submits collection notices and follows up on all patients due collection levels. Makes determination of possible assignment to outside collection agencies by complying with self-pay and bad debt policies.
• Actively works through any denied claims and actively gathers any needed information to take the proper action to ensure the claim is paid. Facilitates any appeals need to by correcting the claims or facilitating an appeal.
• Proactively researches and understand payer issues to troubleshoot the front-end processes that cause the denied claims.
• Identifies coding errors and insures that charges are properly bundled or unbundled. Understands the coding requirements for the governmental and commercial payers.
• Proactively identifies any changes in billing requirements to any governmental and commercial payors. Keeps the practices and billing office staff up to date with these changes.
• Monitors the accounts for any registration / front end errors and makes the supervisor and practice informed of repetitious ones as well as assists with training the practice to reduce these type errors.
• Actively works claims that show no response back from the insurance by running reports and following the necessary steps to ensure that the claim gets processed.
• Promptly answers inquiries from patients, co-workers, and supervisors regarding patient accounts in a kind and courteous manner.
• Identifies credit balances caused by posting errors and or insurance / patient overpayments.
• Assists in providing quality training and orientation for assigned employees.
• Posts and balances all payments, adjustments and denials received on EOBs or ERAs in an accurate and timely manner. Reports any unidentified payments to the audit control coordinator.

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