Insurance and Medical Billing Specialist

Ascend Plastic Surgery Partners MSO LLC•Tuscaloosa, AL

23d

About The Position

We are seeking a part time motivated and skilled Insurance and Medical Billing Specialist to join our team. The Insurance Specialist and Medical Billing professional in a plastic surgery office play a crucial role in ensuring accurate billing, timely reimbursement, and efficient management of insurance-related tasks. This position requires a strong understanding of medical billing and coding practices, as well as excellent communication and organizational skills.'

Requirements

High school diploma or equivalent required; additional education or certification in medical billing and coding preferred.
Prior experience in medical billing, insurance verification, or revenue cycle management, preferably in a plastic surgery or healthcare setting.
Strong knowledge of medical terminology, CPT and ICD-10 coding principles, insurance billing procedures, and reimbursement methodologies.
Proficiency in using billing software and electronic health records (EHR) systems, as well as Microsoft Office applications.
Excellent analytical and problem-solving skills, with the ability to identify billing discrepancies, resolve billing issues, and reconcile accounts receivable.
Detail-oriented with strong organizational skills and the ability to prioritize tasks effectively in a fast-paced environment.
Excellent communication and interpersonal skills, with the ability to interact professionally with patients, healthcare providers, and insurance representatives.
Knowledge of healthcare compliance regulations, including HIPAA and CMS guidelines, and a commitment to maintaining patient privacy and confidentiality.

Responsibilities

Insurance Verification: Verify patient insurance coverage and eligibility prior to appointments, confirming benefits, co-pays, deductibles, and coverage limitations. Communicate insurance information to patients clearly and accurately.
Billing and Coding: Review and accurately assign appropriate CPT and ICD-10 codes to patient encounters and procedures, ensuring compliance with insurance requirements and regulatory standards. Submit claims to insurance companies electronically or via mail in a timely manner.
Claim Submission and Follow-Up: Submit insurance claims promptly and accurately, tracking claim status and following up on unpaid or denied claims. Identify and resolve claim rejections, denials, and other billing issues to facilitate timely reimbursement.
Payment Posting: Post insurance payments, patient payments, and adjustments accurately to patient accounts in the billing system. Reconcile payments received with expected reimbursements and investigate discrepancies as needed.
Accounts Receivable Management: Monitor accounts receivable aging reports and pursue collections on past due accounts. Work with patients and insurance companies to resolve outstanding balances, appealing denied claims and negotiating payment arrangements when necessary.
Insurance Appeals: Prepare and submit appeals for denied claims, providing necessary documentation and supporting evidence to overturn denials and secure reimbursement for services rendered.
Patient Billing and Financial Counseling: Generate patient statements, explaining charges, payments, and insurance adjustments clearly and accurately. Provide financial counseling and assistance to patients regarding payment options, insurance coverage, and financial assistance programs.
Compliance and Regulations: Maintain up-to-date knowledge of healthcare billing regulations, including HIPAA, CMS guidelines, and payer-specific policies. Ensure compliance with billing and coding requirements to avoid audits and penalties.
Communication and Collaboration: Collaborate effectively with healthcare providers, front desk staff, and insurance companies to resolve billing issues, clarify insurance coverage details, and streamline the billing process. Communicate professionally and courteously with patients regarding billing inquiries and concerns.
Documentation and Reporting: Maintain accurate and detailed records of billing activities, claim submissions, payments received, and accounts receivable status. Generate reports and analytics to track billing performance, identify trends, and optimize revenue cycle management.
Adhere to facility policies and protocols.
Advanced knowledge of the types of surgical procedures and treatments offered at the practice.