Experienced Medical Biller/Front Office

Job Responsibilities:

• Performs all duties and responsibilities in a proficient, efficient, team-oriented manner (Examples as follows but not limited to)
• Scheduling Appointments
• Checking in/checking out patients
• Monitor Insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner- knowledge of questions to ask for proper processing.
• Accountable for being knowledgeable and understanding of all aspects of the billing and coding duties, maintains knowledge of and complies with established policies and procedures including government, insurance and third-party payer regulations.
• Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance
• Enter charges accurately according to insurance payors/contracts
• Submitting clean claims by attaching necessary documentation for payment within the Revenue Cycle
• Follow-up on electronic claims and paper claims
• Posting insurance payments to patient accounts
• Submit all secondary claims when necessary
• Identify problem accounts and escalate as appropriate.
• Work with patients and guarantors to secure payment on outstanding account balances.
• Refund money owed to patient or insurances
• Work with other offices to obtain the necessary information to get claims processed.
• EOB functionality
• Other duties may be assigned

Proficiency in the following areas is required:

• Bilingual English and Spanish
• Knowledge of insurance guidelines including HMO/PPO, Medicaid, and other payer requirements and systems.
• Assures accuracy of all CPT, ICD, and HCPCS coding, through familiarity with coding modalities.
• Competent use of computer systems, software, and 10 key calculators. Must be able to become proficient on eMD’s, Meditech computer systems within a reasonable time after training (no more than 30 days).
• Effective communication capabilities for phone contacts with insurance payers to resolve issues.
• Efficient and effective customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse backgrounds and ages.
• Ability to work well in a team environment. Being able to triage priorities, and handle conflict in a judicious manner.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• A calm manner and patience working with either patients, coworkers or insurers during this process.
• Knowledge of accounting and bookkeeping procedures.
• Knowledge of medical terminology likely to be encountered in medical claims.
• Maintaining strict patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Ability to Multitask

Education and Experience Required

• Minimum of 1 to 3 year medical insurance/healthcare billing and collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations
• Minimum of one of the following Medical coding Certifications through either AHIMA, AAPC, or PMI, with the following credentials CPC, CCS, or CMC certifications required. CPEDC an added benefit but not required.
• Associates degree, preferably in business administration or related field

· A combination of education and experience will be considered

· Salary DOE/DOQ

Board Certified Pediatric Physician
Welcoming Professional Environment