Medical Billing Specialist

Mary Free Bed Rehabilitation Hospital•Grand Rapids, MI

6d•$20

About The Position

Medical Billing Specialist/Denial Prevention Analyst is knowledgeable of payer regulations, as it relates to area of billing responsibility to ensure compliance with billing regulations. The Medical Billing Specialist/Denial Prevention Analyst will ensure accurate and timely submission and follow up on inpatient and outpatient claims.

Requirements

High school education or equivalent; associates degree preferred.
Three to five years experience rehabilitation hospital medical billing.
Knowledge of third party billing regulations.
Proficient time management and organizational skills.
Ability to problem-solve and work effectively as a team member.
Effective written and verbal communication skills.

Nice To Haves

Certification as Certified Professional Coder (CSC), Certified Coding Specialist-Professional (CCS-P), or Certified Medical Reimbursement Specialist (CMRS)

Responsibilities

Maintain patient confidentiality as it is described in the HIPAA Privacy Act
Submit timely, accurate and compliant insurance claims by utilizing the billing software
Timely follow up with patients and insurance companies on all unpaid claims until resolution; this includes Understanding payor denial of claims reasons The payor appeals process and sending necessary medical records
Resolve credit balance accounts; this includes Research and understanding of processed claims to determine why there’s a credit balance Work with insurance company to process refunds as appropriate
Reviews explanation of benefits and benefits coverage to determine the best course of action. If needed for further clarification, contact insurance carrier
Analyzes denial trends for staff/organizational education purposes
Identify and report any billing system or payer issues to the Patient Financial Services System Analyst or Manager, as appropriate
Research and identify new or updated billing regulations and notify the Revenue Cycle System Analyst and Manager
Assist patients with payment options by explaining and offering alternative funding options
Handle incoming patient calls/e-mails regarding patient accounts
Assist in identifying additional educational opportunities for training of registration staff with billing regulations/requirements
Responsible for reviewing clinician notes for appropriate documentation to ensure accurate billing
Ensure payer and governmental agency regulatory and compliance requirements are consistently followed and applied
Process insurance rejections, denial, or requests for additional information such as invoices and Medical Records in a timely manner
Research online medical bulletins and policies, pricing and contractual issues
Reviews clinical documentation, coding and claim to determine if the times and services provided to patients were applied correctly
Prepares and mails written rationale of claim reconsideration request
Tracks all denials within a database for reporting
Maintains appropriate established timelines for follow up on outstanding appeal/reconsideration requests
Collaborates with other Revenue Cycle Management and clinical departments to resolve claim issues as needed
Perform other duties as assigned by the Manager
Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.
Contribute by identifying problems and seeking solutions.
Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.