Medical Billing Specialist

The medical biller is responsible for the timely submission of professional medical claims to various payors. Prepare, review, and transmit claims for electronic and/or paper claim submission from the PM system. Responsible for resolving claim edits and clearinghouse rejections via the PM system. Responsible for processing all secondary claims via electronic and/or paper claim submission. Responsible for submitting claims with required documents, per payor guidelines or as requested (i.e., medical records). Review patient statements for accuracy and completeness prior to billing. Maintain a current understanding of local coverage determinations, payor and coding guidelines to ensure claims are consistently billed properly. Perform charge reconciliation from the daily appointment schedule. Perform posting of charges, electronic and/or manual to the PM system. Keep abreast with medical coding updates and educate team members of changes in a timely manner. The specialist will maintain confidentiality and is knowledgeable of AMA CPT, HCPCS, and ICD codes and HIPPA guidelines. Ensure patient and insurance demographics are accurate. Enter and make the appropriate changes in the EMR/PM system(s) regarding insurance and eligibility, and insurance information, as needed. Respond to email and phone calls related to billing and claim submissions. Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor. Ensure appropriate authorization or referral numbers are on the claim prior to submission. Performs job duties with oversight. Other duties as assigned.

Qualifications:

High School diploma or equivalent required 3 years of experience in medical billing strongly preferred 3 years of experience in a specialty group practice preferred Comfortable navigating across various computer systems to locate critical information. Medical billing and coding certification preferred. Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred. Experience with a

CMS-1500

claim form. Experience working with clearinghouses for the purpose of claim submissions.

Job Type:

Full-time Pay:

$26.00 - $28.00 per hour

Benefits:

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

Work Location:

In person