Advanced Medical Billing and Appeal Specialist

Visionary GYN Care • Rockville, MD

418d • $75,000 - $75,000

About The Position

The Advanced Medical Billing & Appeal Specialist at Visionary GYN Care is responsible for managing the Revenue Cycle Management (RCM) process, focusing on claims processing, appeals, payment posting, and documentation. This role requires exceptional skills in medical billing, particularly in handling both in-network and out-of-network claims, ensuring accurate and timely submissions, and following up on denials. The specialist will work closely with the Revenue Cycle team to maintain high standards of accuracy and efficiency in billing practices, while also providing financial counseling to patients.

Requirements

• Bachelor's Degree preferred; some college courses and High School Diploma required.
• 10 or more years of third-party payer billing experience in the healthcare environment.
• Out of network billing experience is required.
• Experience providing patient financial counseling on benefits coverage and patient financial responsibility.
• Experience with EMR, electronic billing systems, and multiple insurance verification portals required.
• Excellent written and verbal communication skills.
• Strong organizational skills and ability to meet deadlines.
• Ability to multi-task, prioritize, and manage time effectively.
• Strong computer skills including proficiency in Microsoft Office products and medical software.

Nice To Haves

• Experience with ICD-10 for 5 years or more.

Responsibilities

• Claims processing including timely filing of appeals and payment posting.
• Diligent follow-up on all claims, both out of network and in network.
• Sourcing EOBs from payors or patients as required.
• Managing appeals for all nonpaying or low paying claims in network and all claims out of network until a final decision is made.
• Documenting all information into an EHR system for follow-up and review.
• Communicating effectively to ensure a cooperative work environment.
• Ensuring all claims are submitted with a goal of zero errors.
• Accurately posting all insurance payments by line item.
• Responding to inquiries from insurance companies, patients, and providers.
• Providing financial counseling to patients regarding their financial responsibilities.
• Fulfilling medical records/audit requests and submitting billing data to insurance companies.
• Following up on missed payments and resolving financial discrepancies.
• Assisting with appeals for payment denials and incorrectly paid claims.
• Utilizing monthly aging accounts receivable reports to follow up on unpaid claims.
• Verifying and understanding insurance information and answering patient inquiries on benefits coverage.

Benefits

• Competitive salary
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• 401(k)
• 401(k) matching
• Employee assistance program
• Employee discount
• Paid time off

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED