Billing Specialist

Advance Community Health•Raleigh, NC

31d

About The Position

The Billing Specialist will be responsible for ensuring claims for patient services are accurately and timely filed and paid for his/her specified payer panel. The Billing Specialist will collect and enter claim information and post insurance and patient payments. Subsequently, he/she will work collaboratively with other members of the organization to maximize accuracy, efficiency and promptness of the claim life-cycle.

Requirements

High School diploma or GED required.
Two years of experience in billing operations, preferably in a healthcare facility.
Demonstrated billing coding knowledge in order to adequately process billing and communicate effectively with providers.
Demonstrated efficient keyboarding (data entry and typing skills).

Nice To Haves

Knowledge of FQHC billing.

Responsibilities

Claim Management - Responsible for primary and secondary claims process from submission to payment.
Submits clean claim to clearinghouse or insurance company electronically or via paper CMS-1500 form.
Follows up with insurance company on denials or rejected claims. Resolves issue and resubmits claim.
Documents denial and rejections and provides input on procedure changes to ensure accuracy and efficiency.
Prepares appeal letters and submits appropriate documentation to substantiate appeal.
Ensures electronic and manual payments are properly posted in medical claim billing software.
Clean Claim Verification - Assures claims are clean and ready to file for assigned payer panel.
Resolves duplicate ticket issues.
Reviews chart documentation for correct coding and additional revenue opportunities
Ensures accurate use of modifiers.
Reviews demographic and patient insurance information for completeness
Corrects minor issues.
Initiates communication needed to resolve claim issues, monitors until issues resolved, escalating as needed.
Patient Customer Service - Effectively communicates patient balances.
Responds to patient inquiries.
Assists with processing patient statements for charges not covered by insurance.
Assists with processing past due balances to collection agency.
Workflow Analysis - Measure accuracy, quality of work output and compliance with Advance established policy and procedures related for assigned payers.
Maintain system for tracking and reporting claim errors by individual and site.
Maintains reporting of point of service and daily deposit collections by individual and site.