Purpose of the Job: Seeking an experienced Medical Billing Specialist in our nonprofit division. A self-starter who will take on responsibilities for submitting clean claims to commercial/private insurance companies, Medicaid/MCOs, and health and human service clients.
Basic Function: Strong background in medical billing, with the skills necessary to improve our current billing procedures and reduce A/R days. The successful applicant will work on multiple tasks requiring data analysis, in-depth evaluation and exercising judgment within the appropriate scope of practice.
Key Result Areas (Principal Accountabilities) :
• Having proper knowledge of submitting claims: Paper, electronic
• Knowledge of medical billing forms: CMS-1500 vs UB-04, Medicare and Medicaid/MCO
• Prior experience in working with clearinghouse – balancing claims: Submissions/Denials/Rejections/Pending/Not Received. Balancing Reports to ensure all vouchers captured and resolved timely
• Understand the components of a clean claim to ensure first time submission
• Provides that insurance verification is completed timely – notifies staff of eligibility concerns, corrects encounter data
• Complies with payor-specific requirements
• Knowledge of coding for services (dx and cpts) and procedures
• Works denials timely and is proactive in denial prevention. Monitors and communicates trends, makes appropriate corrections and resubmissions.
• Assists with revenue recognition and preparation of key charge backup
• Ability to post payments and adjustments timely and accurately. Understands RAs and CARCs and appropriate posting and subsequent actions
• Ability to post Credit Card transaction/follow up on expired, Check posting, EFT validation and posting
• Previous knowledge of posting via ERA and manual intervention, audit patient accounts for proper posting
• Resolving secondary insurance and coordination of perks
• Researches variances and reports findings to direct supervisor
• Balanc