Medical Billing and Claims Associate

The Medical Billing and Claims Associate is responsible for accurately and timely analysis medical records and assigning standardized codes to diagnoses, procedures, and services for billing and record-keeping. The Medical Billing and Claims Associate accurately translates patient information into alphanumeric codes using systems like ICD, CPT, and HCPCS, ensuring proper reimbursement and maintaining data integrity, and processing patient health insurance enrollment/waiver verification, in-office and third-party billing, and claims while providing outstanding customer service. 

The Medical Billing and Claims Associate reviews billing reports and insurance claims for accuracy, updating and editing Electronic Medical Records software. This position processes billing functions in the POS and EMR systems, Student Health Insurance submission and verification, and claims. Under the direction of the Assistant Director of Health Insurance, Billing, and Claims, the Medical Billing and Claims Associate processes data entry via students’ email and Insurance software submission of health insurance documentation for Student Health Insurance waivers. Additionally, processes data entry and verification for patient Health Insurance card submission in the EMR system, ensuring all patients with Health insurance have submitted documents prior to the scheduled appointment. Communicates with students regarding the procedures and updates to submit the Student Health Insurance waiver and enrollment process and deadline. Supports students enrolled in the Student Health Insurance Plan with reviewing their health insurance account, receiving their insurance card, submitting claims, adding dependents, etc.

Duties and Responsibilities

• Apply the appropriate ICD-10, CPT, and  HCPCS codes to ensure claims are billed correctly. Monitor and process claims for insurance reimbursement, ensuring accuracy and compliance with all federal, state, and payer-specific guidelines. Conduct a detailed analysis on denied claims and submit appeals when necessary. Review, follow up, and resolve outstanding claims with insurance companies to maximize reimbursement. Conduct a detailed analysis on denied claims and submit appeals when necessary.
• Processes in office and third-party billing operations, including medical coding, charge entry, claims submissions, payment posting, reimbursements, refunds, and fee schedule, etc. Processes in office billing functions in the Electronic Medical Records system and the Point of Sale system. Responsible for using revenue management software to identify and resolve coding and claim edits. Enters, reviews, and verifies patient health insurance information submission in the Electronic Medical Records system before the appointment. Processes refunds and posts payments on patient accounts. Post insurance payments to patient accounts.