Medical Billing Specialist (Onsite)

Frederick Foot and Ankle Specialists, P.C.•Frederick, MD

98d•Onsite

About The Position

The Medical Billing Specialist is responsible for accurate claim submission and reimbursement while following established company and departmental production and quality standards, policies, and procedures. The role assists the billing manager with insurance and billing clerical duties, prepares and submits claims using physician-provided fee tickets and electronic health record data, and verifies patient account information against insurance requirements. Claims must not be changed from the fee ticket without billing manager authorization. The specialist obtains missing information needed to file claims, responds to routine billing inquiries, follows up on insurance balances, verifies payments against contracted amounts, and processes claims, denials, appeals, and adjustments. The role also maintains task records and reports, supports account and collection issue resolution, represents FFA in meetings with billing partners and related organizations, and adheres to applicable regulations and FFA's Compliance Program. The position requires clear communication with patients, colleagues, and the public, and participation in mandatory training on healthcare billing requirements.

Requirements

High school diploma or GED.
Knowledge of medical billing and insurance claim filing.
Knowledge of ICD-10 and CPT-4 coding, including modifiers.
Ability to make and evaluate judgments, with strong organizational, problem-solving, and analytical skills.

Nice To Haves

1–2 years of experience preferred.

Responsibilities

Assist the billing manager with insurance and billing clerical duties.
Report unclear claims, tickets, charges, payments, or other information or communications, and matters inconsistent with FFA billing rules, to the billing manager.
Generate and submit insurance claims using data from physician fee tickets and the electronic health record; obtain billing manager authorization before changing information from a fee ticket.
Review patient account information against insurance program specifications and update information as necessary.
Obtain missing claim information from patients or other FFA staff, including referrals, updated insurance information, and authorizations.
Resolve routine patient billing inquiries and problems.
Follow up on balances due from insurance companies and verify that payments match contracted amounts.
Submit claims according to billing policies and procedures, including following up on third-party approvals and collecting overdue patient accounts.
Process claims, denials, appeals, and adjustments in accordance with established policies, regulations, procedures, and standards.
Communicate with the billing manager to resolve delinquent account, collection, special adjustment, and write-off issues.
Keep staff checklists current and log all claims worked in the Staff Log.
Prepare or maintain reports on billing and collection activities for the billing manager and physician review as requested.
Represent FFA at business meetings with billing partners, clients, hospitals, and related organizations.
Ensure compliance with applicable industry rules and regulations.
Participate in mandatory company training on healthcare billing laws, rules, regulations, and developments.
Prioritize patient communications according to medical need and urgency.
Communicate clearly and maintain effective working relationships with patients, FFA staff, and the public.
Perform other job-related duties as assigned or required.
Read, understand, and adhere to FFA's Compliance Program.