Under the supervision of the Billing Manager, the Medical Billing Specialist is responsible for preparing and submitting timely and accurate insurance claims to third party payers, assisting in the implementation of payer regulations and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract, or other regulations or agreements. The Medical Billing Specialist is responsible for appropriate follow up on all accounts pending payment from government and third-party payers.
DUTIES AND RESPONSIBILITIES
· Prepares and submits clean claims to various insurance companies either electronically or paper.
· Reviews and posts denials to accounts according to the EOB to ensure accurate payment status and account activity.
· Monitors aging reports and take necessary actions to guarantee payments of claims.
· Reviews accounts daily and makes phone calls to assigned insurance groups for insurance follow-up to determine claim adjudication.
· Identify payments or adjustments that require review by insurance companies. Takes necessary actions (i.e., sends letters, initiates phone calls, or obtains medical records) to prepare a review to send to the insurance company. Track the account until the correction is made.
· Assures compliance with applicable billing laws and regulations to maximize cash receipts.
· Identifies accounts that have been overpaid and initiate refund requests to patients and/or insurance as appropriate.
· Contacts insurance carriers regarding non-payments and/or improper payment on claims.
· Identifies problem accounts with payers; investigates and correct errors follow-up on missing account information, and resolves past-due accounts.
· Prepares reports to identify and resolve accounts receivable.
· Serves as a back-up to the Payment Poster, posts payments to accounts, and checks for accuracy and compliance with contract discount if applicable.
· Posts ERA payments, adjustments, and write offs to appropriate accounts.
· Prepares, reviews, and send patient statements.
· Answers inquires by phone regarding past-due accounts and insurance guidelines; researches incorrect addresses for past-due accounts.
· Follows internal policies and procedures for payment posting guidelines relating to payer fee schedule.
· Transfers bills to secondary or tertiary accounts, if applicable.
· Makes adjustment to either patient or practice accounts based on internal reports and/or documentation.
· Responsible for reading and understanding various types of Explanation of Benefits.
· Keeps supervisor informed of areas of concern and problems identified.
· Assists with yearly financial audit.
· Maintains strict confidentiality regarding confidential conversations, documents and files.
· Participates in educational activities and attends monthly staff meetings.
· Adheres to all HIPAA guidelines/regulations.
· Performs other duties as assigned.
- High School diploma or GED required/Associates' degree preferred.
- Completion of program in medical billing or certification program preferred.
- Understanding of payer EOBs/Remits.
- Strong computer skills including Microsoft Word, Excel, and fast and accurate typing skills.
- Minimum of 3-5 years' experience using ICD-9-CM, Volumes 1- 3, CPT, HCPCS, and IHS coding conventions.
KNOWLEDGE & EXPERIENCE REQUIRED BY THE POSITION
· Must demonstrate ability to work independently with minimum supervision in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs.
· Advance knowledge of medical codes involving selections of most accurate and description code.
· Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
· Excellent oral, written, and telephone communication.
· Working knowledge of rules and regulation pertaining to the FQHC guidelines.
· Ability to prioritize and manage multiple tasks with efficiency in dealing with multiple facilities.
· Ability to handle a large volume of project receiving and researching claims.
· Excellent computer skills, including Excel, Microsoft Word, etc.