Billing Specialist I
About The Position
This position is primarily responsible for reviewing, editing, and submitting clean claims in a timely manner for medical services provided in a medical office setting. The Billing Specialist I role involves accepting and reviewing patient encounters for accuracy, collaborating with providers and other internal resources to capture relevant billing information, and entering or editing information necessary for insurance claims. The role also includes verifying patient benefits eligibility, identifying and resolving missing or incomplete charge data, preparing and submitting clean claims to insurance carriers, and resolving front-end edits. Additionally, the position requires following up with insurance companies on unpaid or rejected claims, assisting with inquiries, attending meetings, and maintaining patient and financial confidentiality in accordance with HIPAA guidelines. The Billing Specialist I must also stay knowledgeable about governmental regulations and company policies.
Requirements
- Must have high school diploma or equivalent
- One (1) or more years of medical billing, coding, and/or AR Follow-up
- Demonstrate a professional approach to daily responsibilities while contributing to a positive, team-oriented work environment
- Knowledge of third-party payers and prior-authorization requirements
- Comprehensive understanding of medical terminology and procedures
- Working knowledge using ICD-10 and CPT codes
- Working knowledge of medical billing for office visits
- Proficient use of office equipment, such as copier and fax machine, phones, etc.
- Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical records systems.
- High attention to detail and the ability to multi-task.
- Strong time management skills
- Ability to work independently with minimal supervision and to manage multiple priorities.
- Strong written and verbal communication skills
- Ability to effectively communicate with a variety of people under stressful circumstances.
- Neat appearance, professional demeanor and pleasant voice
- Fluent in English
Nice To Haves
- Experience with gGastro/ModMed
- Experience in GI
Responsibilities
- Accepts and reviews patient encounters for accuracy and follows standard quality review procedures on each encounter posted
- Collaborates with providers, referring physician offices, nursing, scheduling, and other internal resources to understand and capture relevant billing information
- Enters or edits information necessary for insurance claims such as patient, insurance ID, payer, provider information, diagnosis, treatment codes and/or modifiers
- Verifies patient benefits eligibility and coverage
- Identifies missing or incomplete charge data and works to obtain and process in a timely manner
- Prepares and submits clean claims to insurance carriers either electronically or on paper as determined by the carrier
- Resolves front-end edits generated from the system, clearinghouse or payer, and resubmits claims for processing
- Identifies key trends and works with the Revenue Cycle Lead or Revenue Cycle Manager to resolve issues
- Follow up with insurance company on unpaid or rejected claims.
- Resolve issue and re-submits claims
- Assists with inquiries regarding claims and non-covered charges
- Attend meetings and training sessions
- Maintain confidentiality of patient and financial information by utilizing HIPAA guidelines and regulations
- Maintain knowledge and adhere to related governmental regulations and all policies set forth by Ohio Gastroenterology Group Inc and its related parties
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
