Medical Billing Specialist

The Medical Billing Specialist plays a key role in optimizing reimbursement by sending clean claims to the insurance companies, working insurance claim denials efficiently and quickly the 1st time and having that in-depth knowledge of medical coding and billing guidelines.

 Rejected EOB

·         Follow-up on denials on the Practice Management Dashboard.

Appeals

·         Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier.

Appeals Completion

·         Complete the appeals, reopening, redetermination, etc. in it’s entirety and send all required documentation to the insurance carrier.

Carrier Calls

·         Call insurance carriers to appeal payments that do not match contractual agreement. 

·         Notify supervisor of consistent contractual agreement discrepancies.

Patient Inquiries

·         Respond appropriately and accurately to written and telephone inquiries from patients regarding their insurance questions and account balances.

Claims Worklist

·         Review and work the claims worklist daily.

Unapplied Payments

·         Review and work the unapplied payments and credit balances daily.

 In-actives

·         Use data from in-actives on the practice management dashboard, call payers or look up claim status on-line to inquire about unpaid insurance claims that are 45 days old; record response or activity in the computer.

Medical Record Requests

·         Make necessary arrangements for medical records requests, completion of additional paperwork, etc.

Carrier Relationships

·         Manage relationships with personnel from assigned carriers.

Manager Meetings

·         Meet with manager regularly to discuss/resolve reimbursement and insurance follow-up problems.

Refund Requests

·         Process requests for refunds and submit all required documentation to manager for approval.

Insurance Inquiries

·         Respond appropriately and accurately to written and telephone inquiries from insurance companies.

Medical Billing Knowledge

·         Knowledge of medical billing policies and procedures.

Insurance Provider Policy Knowledge

·         Knowledge of insurance provider policies and procedures regarding patient claims.

Accounting Principles

·         Knowledge of basic accounting principles.

Medical Terminology Knowledge

·         Knowledge of medical terminology and basic human anatomy.

Working Relationships

·         Ability to establish and maintain effective working relationships with physicians, co-workers, and the public that harbor a friendly, yet professional interaction.

·         Demonstrate willingness to readily interact with other staff members and department.

Flexibility & Stressful Situations

·         Ability to be flexible, organized, and function under stressful situations.

Benefits

•  Health, vision and dental insurance
• 401(k) with matching opportunities
• PTO
• Paid holidays
• Advanced training and professional development opportunities
• Salary: starts at $40,000 per year, based on experience and education.