JOB SUMMARY

The Billing Specialist has the responsibility for accurate and timely preparation and submission of all claims (electronic and paper) to intermediaries and third party carriers. This position will assist the management team with oversight of both the billing and cash application processes by serving as a liaison between the client and other departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Directly responsible for researching/handling questions regarding any eligibility or billing issues in a professional and timely manner. Responsible for keeping accurate information on all patient referrals payments to assure we need to pay them. Communicates through Nextgen on any errors or omissions to providers promptly, performs follow up and corrections ensuring timely filing of claims with insurance carriers. Responsible for reviewing all denied claims, timely follow up and files appeals on denial determinations as necessary. Notifies Finance Manager of any trends identified. Manages inbound calls from patients, healthcare center staff, and hospital personnel for inquiries on services provided, financial responsibility and insurance coverage issues. Assists with maintaining new and existing billing policy guidelines and documented procedures for medical billing. Call payers when necessary to determine how and where to send claims for payment. Generate billing spreadsheet when necessary. Balance daily cash received and maintain and update the Corporate Reconciling spreadsheet. Maintain weekly adjustment logs. Recognize and forward all incorrect payments to Finance Manager for follow up. Process patient refund requests. Perform all other duties as directed either formally or informally, verbally or in writing.

SUPERVISORY RESPONSIBILITIES

No direct supervisory responsibilities

KNOWLEDGE, SKILLS AND ABILITIES

Working knowledge of medical terminology. Must be able to work independently while utilizing strong critical thinking/time management skills. Must be able to type 45 words per minute. Strong computer skills, with proficiency in Microsoft Office. Must possess good "customer service" including verbal and written communication. A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times. Possess strong interpersonal skills and ability to work well with others. Ability to deal effectively with changing situations and stressful environment.

EXPERIENCE AND EDUCATION

High school diploma or equivalent required. Minimum of one (1) year of experience in medical billing, medical insurance, healthcare revenue cycle, or a related healthcare administrative role required. Associate's degree in a related field and/or Medical Billing Certificate from an accredited institution preferred.