Medical Billing Specialist (Hybrid)

Title of Position: Billing Specialist

Nature of Position: The billing specialist will be responsible for working with the team to ensure that

claims are processed promptly and efficiently.

II. Responsible to: Revenue Cycle Manager

III. Responsibilities:

• Data Management Specialist
• Checking eligibility and benefits verification for office procedures.
• I'm looking over the patient bills for accuracy and completeness, and obtaining any missing information.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Encounter Review of charts to ensure codes/charges are accurate.
• Working daily schedules from offices to ensure all charges are captured.
• Following up on unpaid claims within the standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances.
• Reviewing accounts for insurance of patient follow-up.
• Claim Denial Management: refiling, researching, and appealing denied claims.
• Answer all patient or insurance telephone questions about assigned accounts.
• Setting up patient payment plans and work collection accounts.
• Updating cash spreadsheets, and running collection reports.
• Posting all insurance payments received, as assigned.
• Working with sites to ensure that payments are posted daily and information is accurate
• Daily posting and balancing, as assigned
• Auditing Sliding Fee Scale (SFS) applications for all medical sites. Ensures applications are complete and the front desk staff has collected proper documentation.
• Become an SFS subject matter expert to handle all SFS questions/issues.
• Ensures SFS is properly entered into eCW
• Works with Site Leads on any errors identified
• Follow up on errors to make sure corrections have been made
• Works with the Billing Team to ensure claims have slid correctly after corrections are made
• Assist the Billing Team with special projects as needed
• Once SFS claims are caught up, assist the front desk with identifying patients with expiring slides.
• Other duties as assigned

A. High school diploma or GED; Coding/Billing certificate a plus.

B. Two years of medical office experience, billing experience a plus.

C. Competent with computers including experience in Microsoft Windows/Office programs, specifically

Microsoft Word and Excel.

D. Excellent customer service to both internal and external customers

E. Willingness to work cooperatively in a team setting

F. Ability to demonstrate accuracy and thoroughness ensuring the highest possible quality.

G. Ability to maintain a strong work ethic without direct supervision at all times

H. Effective oral and written communication

I. Ability to make timely, informed decisions that consider the facts, goals, constraints, and risks related to

all aspects of the organization

J. eClinicalworks knowledge is strongly preferred.