Billing Specialist

Healthcare Outcomes Performance Co. (HOPCo) • Phoenix, AZ

9d

About The Position

The Billing Specialist is responsible for maintaining productivity and accuracy metrics, working claim errors in the claims management system to ensure clean claims are submitted timely to insurance carriers. This role involves reviewing insurance rejections, determining appropriate action steps, and obtaining necessary information for resolution. The specialist will also correct and identify billing errors, resubmit claims, and verify patient demographic and insurance eligibility information, including coordination of benefits. Additionally, the role assists in identifying and communicating trends or potential issues to the management team, manages payer website user access, and maintains system data for Athena master files, including referring provider information, insurance plan details, and payer enrollments. The position is also responsible for EDI, ERA, and EFT enrollments for all payers.

Requirements

• High school diploma or GED
• Minimum two to three years of experience in medical billing.
• Experienced candidates will have prior experience working claim errors in a claims management system.
• Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
• Advanced computer knowledge, including Window based programs.
• Demonstrated knowledge of revenue cycle applications.

Nice To Haves

• Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.
• Prefer prior experience configuring revenue cycle vendor-supplied software.

Responsibilities

• Maintains productivity and accuracy metrics per department expectations.
• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Assist in identifies and communicating trends and/or potential issues to management team.
• Payer website user access maintenance.
• Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
• Responsible for EDI, ERA and EFT enrollments for all payers.

What This Job Offers

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