Medical Billing Specialist

VITAS Healthcare•Miramar, FL

23h•Onsite

About The Position

The Medical Billing Specialist is responsible for meeting established daily productivity standards, scheduling and downloading daily bill job files, and processing them for transmittal. This role involves researching, correcting, and re-submitting rejected and denied claims, ensuring timely billing through paper or electronic claims in the appropriate format. The specialist monitors insurance claims by running reports and contacting insurance companies to resolve unpaid claims, requiring knowledge of proper processing questions. Key responsibilities include identifying and resolving billing issues, escalating problem accounts, and updating patient account records with actions taken. The specialist manages clearinghouse and payor accept/reject reports, resolving claim rejections within 72 hours, and logs repetitive errors for management reporting. Coordination with collectors and management is essential to stay updated on payer demands and requirements across states. The role also involves interacting with other departments to troubleshoot issues, providing support to collectors with billing documents, staying abreast of editing process changes, and acting as a resource for billing information. Identifying and correcting coding or billing problems from EOBs in a timely manner is crucial. The specialist serves as a subject-matter expert for billing specifications of assigned payers and states and understands Hospice Notice of Election (NOE) submission timing requirements and exceptions.

Requirements

Three to four years prior experience in a general office environment.
Knowledge of insurance billing guidelines including Medicare, Medicaid, and other third party payers.
Possess a full understanding of the health care collections and reimbursement process, and an in depth knowledge of the insurance industry.
Ability to work on various assignments simultaneously.
Strong interpersonal skills within all levels of the organization.
Ability to navigate within automated systems and proficiency in Outlook, Word and Excel.
Completion of high school or basic education equivalency required.

Nice To Haves

Accounting or billing experience in a healthcare environment preferred

Responsibilities

Meets established daily productivity standards.
Schedule and download the daily bill job files and processes for transmittal.
Research, correct, and re-submit rejected and denied claims.
Responsible for timely billing whether by paper or electronic claim in the appropriate claim format.
Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner- knowledge of questions to ask for proper processing.
Responsible for identifying problems and solutions or enhancements to resolve billing issues including, but not limited to, billing frequency, required forms, and general billing requirements.
Identify problem accounts and escalate as appropriate.
Update the patient account record to identify actions taken on the account.
Manages clearinghouse and payor accept/reject reports timely while ensuring all claim rejections are resolved within 72 hours of rejection occurrence.
Logs repetitive errors or exceptions and reports them to management to ensure the admission record and related systems are properly updated and corrected.
Coordinates with collectors and management to become familiar with the changing demands and requirements of payers in each state.
Interacts with other areas and departments to troubleshoot and resolve issues that may not have standard documented solutions.
Provide support to the Collectors by producing timely, accurate and complete billing documents.
Stays abreast of changes in all editing processes as may be required.
Acts as a resource for billing information and assists collectors and other staff members in producing any special documentation which may be required.
Identify coding or billing problems from EOBs and work to correct the errors in a timely manner.
Understand and serves and as subject-matter expert for billing specifications and requirements of assigned payers and states.
Understand Hospice Notice of Election (NOE) submission timing requirements and exceptions.