Billing Specialist

Masonicare Corp•Wallingford, CT

29d•Onsite

About The Position

Under general supervision from Patient Accounts Management, The Billing Specialist performs a variety of complex operations related to the eligibility, claim preparation, claim submission, suspense resolution, claim follow up and credit balance adjudication/reporting for healthcare services provided to Medicare, Medicaid and Commercial Primary/Secondary beneficiaries. Submits third party claims and resolves billing, payment and collection issues.

Requirements

High School Diploma or GED
1 to 3 years’ experience in healthcare billing.

Responsibilities

Review-reports to identify claims that are eligible for billing to intermediaries, insurance companies, third parties and patients. Processes claims and bills in Electronic Medical Record (EMR) system following established procedures.
Works with - operations to resolve - issues that impact claims processing. Brings problems and delinquent responses to the attention of Manager. Process- corrections - and generate- claims for re-processing. -
Reviews denials and zero pay claims from payor remittance advices, research issues and prepare-claims for resubmission.
Monitors unpaid claims via accounts receivable -aging, initiate- timely follow up calls and resubmit- claims and/or supporting information to receive- payment from payor. Work- under the direction of Manager to oversee timely collection- - -.
Maintains detailed claim history in collections database. Maintains statistical data and records. May prepare regularly scheduled or special reports on claims, suspense, denials, credit balances and payment activity.
Responds by telephone or correspondence to inquiries from patients, family, intermediaries or payers. Explain benefit coverage to patients, research- problems and correct-errors.
Identifies and investigates problem delinquencies; follow through with collection policy prior to referral to collection agency, legal action, or write off.
Meet- defined productivity metrics set up by Manager and maintain- - high-quality standards - -.
May assist in preparing documentation for appeals, third party audits, legal inquiries, litigation, and court appearances. Assists in special projects as needed. Perform general clerical duties to support the -team.
Work as a -cross-functional team member b=by providing training to others and -furthering training in our current systems as -appropriate. -Assist in documenting step-by-step task process- for each task and maintain a process manual at workstation.
Follows established departmental policies, procedures and objectives.
Performs miscellaneous job-related duties as assigned.