Billing Specialist II

PROMETHEUS LABORATORIES INC•San Diego, CA

8d•$30 - $35

About The Position

The Billing Specialist II will be responsible for supporting financial objectives through strategic and tactical activities, actively engaging with payors, providers, and patients, resulting in the highest-level reimbursement on submitted claims. The Billing Specialist II is responsible for the optimal payment of claims from Medicare, Medicaid, BCBS, Contracted, Commercial and Manage Care Plans. The Billing Specialist II will work closely with Customer Experience Specialists. Assists in the training and development of Billing Specialist I team members while supporting a range of functions across the PRCE department as needed.

Requirements

High School Degree/General Education Degree and 4 years of relevant experience in Customer Service, medical industry or relevant experience as outlined in the essential duties in lieu of bachelor’s degree.
4+ years of experience in customer service, billing, denial management and eligibility verification
Demonstrated ability to think critically and apply customer lens judgement in actioning and resolving inquiries.
Strong understanding of customer service, medical billing, insurance, and data entry.
Advanced proficiency in customer service systems, CRMS, Phone systems, Billing Platforms.
Fluency in English required.
Proficiency in Microsoft Office, to include Word, Excel, Outlook, SharePoint.
Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
Maturity and good judgment to understand when to exercise initiative and handle queries directly, and when to escalate queries to higher authority.
An excellent team player – highly effective at working with others and capable of working independently most of the time.
Ability to multi-task and attention to detail.
Must be able to work in a fast paced, time-sensitive environment.
A deep understanding of insurance denials drivers and an overt willingness to be an internal champion for both the patient and health care providers.
Must have superior interpersonal and organizational skills.
Excellent listening, oral and written communication skills.
A high level of empathy, enthusiasm, and self-confidence.
Effective written and verbal communication
Should be familiar with accessing Medical Coding (CPT & Diagnostic Codes) and HIPPA rules and regulations.
Should understand medical terminology, EOB’s and CMS 1500's and insurance classifications such as HMO, PPO, Medicare and private insurances.
Computer skills required to operate practice management system (i.e., use Window operating system, conduct Internet searches, communicate by email, etc.)

Nice To Haves

Spanish / Bilingual a plus
Clinical / Medical or other ancillary service type background.
Minimum of 4 years appeal experience in Health Care, Lab, DME Pharmaceutical industry preferred.
Bachelor’s Degree preferred.
Significant PC knowledge & Windows OS experience.
Skilled competence with Five9, XiFin, Microsoft Office, Salesforce.com a plus.
Familiarity with insurance plans, third party administrators, and governmental rules and regulations preferred.

Responsibilities

Consistent follow up on unpaid, underpaid & denied claims and following up on no appeal responses.
Filing appeals when appropriate to obtain maximum reimbursement, establish and maintain strong relationships with providers, clients and fellow staff, and monitor trend in denials of payment changes.
Partner with management to identify trend in denials, identifying root cause of denied claims and implement strategies to prevent claim denials.
Investigates insurance denials and identifies and implements best recommended action and coordinates with other departments/stakeholders as needed.
Solves billing questions/problems and audits patient accounts.
Understands and adheres to each insurance carrier’s reconsideration and appeal submission guidelines.
Makes necessary adjustments to patient balances based on Explanation of Benefits (EOB).
Determines need for payer appeal and sends individual appeal letters. Monitors appeal for resolution.
Excellent customer service skills – communicates effectively with patients to retrieve required consent forms and providers to retrieve required records.
Reviews and analyzes insurance claims with accounts receivable balances that are aged beyond 30 days old.
Access denied claims from RPM system work queue and queries claim status with the payor, utilizing all appropriate systems, websites to effectively research the claim and resubmit or appeal as necessary.
Makes necessary arrangements for medical records requests, completion of additional information requests etc. as requested by insurance companies to ensure timely resolution of outstanding denied/unpaid claims.
Assist in resolving clearinghouse and insurance claim errors to ensure timely and accurate claim submissions based on business needs.
Assist in various functions of the billing department, including payment posting, client bill, CEX and order processing based on business needs.
Prioritize claims based on ageing and outstanding dollar amounts, or as directed by management.
Regularly meets with PRCE Management to discuss challenges or billing obstacles as well as to provide status of outstanding ageing reports worked.
Follow all compliance and HIPAA standard when documenting accounts and communicating with patients.
Ability to handle multiple projects at the same time but remain organized – strong sense of urgency for schedules.
Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
Regular and reliable attendance.
Other duties and responsibilities as assigned.