Medical Billing Spec

OSS Health•York Township, PA

About The Position

The Medical Billing Specialist is a key member of the Revenue Cycle team responsible for ensuring that the organization receives proper reimbursement by reviewing payer requirements, correction of errors and supporting Patient Financial Services and the patients with billing inquiries.

Requirements

High school diploma or equivalent is required; Associate Degree or Accredited Certificate from a Medical Billing program is preferred.
At least 2 years’ experience in medical insurance billing for a hospital, clinic, or doctor’s office.
Must be detail oriented and possess excellent organizational skills, time management and communication skills
Must have a working understanding of hospital and/or physician claim requirements for Medicare, Medicaid, Commercial Healthcare Insurance.
Must be able to prioritize duties and communicate directly with insurance companies, patients, physicians, co-workers and vendors.
Must be a team player and willing to work with all staff to get the overall job accomplished. Must maintain a cooperative working relationship with all and handle difficult situations tactfully.
Must have the ability to review and understand written material pertaining to orthopaedics and general healthcare, including terminology and reimbursement issues.

Nice To Haves

Experience with Medent, CPSI and SSI software preferred.

Responsibilities

Verify claim accuracy, including demographics, insurance coverage, coding, modifiers and required documentation.
Correct and resubmit rejected or denied claims promptly
Communicate with payers to resolve delays, denials and underpayments.
Document all account activity in billing systems per department standards.
Review denial codes and explanation of benefits (EOBs) to determine root causes
Initiate corrections, appeals or re-billing procedures as needed.
Work with coding, clinical and front-end teams to prevent recurring errors.
Assist patients and patient financial services with billing questions, statements, and balance questions.
Ensure billing practices comply with payer policies, CMS regulations and organizational standards.
Maintain thorough, accurate records of billing actions and follow-ups.
Support audits and quality reviews.
Escalates difficult or recurring issues to the Revenue Cycle Manager to identify a trend, resolve the isolated issue or render correction to the billing process.
Demonstrates good judgment in safeguarding OSS information to include confidentiality of all medical and patient information.
Resolution of any Coordination of Benefits, Self-Pay Adjustments or Bundled Pricing
Follows all policies and procedures of OSS.
Other duties as assigned.