Medical Billing Specialist

Appalachian State University•Boone, NC

About The Position

The Primary Purpose of this Position is to execute all billing and credentialing for all AppWell clinic facilities. This includes claims submission, revenue cycle management, patient billing, and ensuring compliance with HIPAA regulations. The role also involves providing front desk backup support, training student interns and employees, and serving as a mentor. Additionally, the specialist will execute insurance provider enrollment and credentialing processes, maintain provider profiles, ensure proper use of billing codes, and stay updated on billing codes and procedures. Balancing end-of-day transactions and tracking payments from various sources are also key responsibilities. The role requires obtaining prior authorizations as needed for allied health provider services.

Requirements

Knowledge of HIPAA regulations.
Bachelor’s degree; or equivalent combination of training and experience.
All degrees must be received from appropriately accredited institutions.

Nice To Haves

Basic office skills
Supervisory skills
Ability to produce and evaluate data
Ability to work independently and without instruction
Ability to handle pressures
Ability to prioritize work and stay focused in a busy environment
Ability to make administrative decisions
Ability to be patient and flexible in a demanding environment
Ability to provide instruction and oversight for graduate assistant students
Knowledge of electronic health records
Knowledge of private-pay, third party and insurance billing, including claim submissions
Certificate or associate’s degree in medical billing and coding

Responsibilities

Prepare, review, and transmit claims to insurance companies (commercial and government) for reimbursement.
Monitor claim status, follow up on unpaid claims, and appeal denied claims to ensure timely payment.
Calculate patient responsibility, send patient statements, and handle inquiries about bills.
Adhere to HIPAA regulations to maintain patient confidentiality and comply with all legal/payer requirements.
Provide front desk back up support to the LLHS Clinic Front Desk as needed.
Be available to train student interns, graduate assistants, and student employees as appropriate.
Serve as a mentor modeling professional behavior.
Execute Insurance provider enrollment processes and set up.
Execute Initial setup and maintenance of credentialing for all affiliated providers.
Update and maintain all CAQH Provider Profiles.
Proper use and assignment of billing codes.
Stay up to date on appropriate billing codes and procedures.
Balance end of day according to clinic policies and procedures.
Track payments from all sources including Touchnet, Clover, Zealous, Availity, WayStar, (and others) as well as Student Accounts.
Obtain prior authorizations as needed for allied health provider services.