Medical Billing Specialist
About The Position
Our Medical Billing Specialists ensure efficient filing and resolution of insurance claims; acting as liaison between doctors, insurance companies, and patients. Essential Duties and Responsibilities include the following. Other duties may be as assigned. Monitors and evaluates insurance reimbursements and requests review of questionable reimbursements on a claim-by-claim basis and by procedure code. Obtains accurate billing information from patients and insurance companies. Consults physicians and/or the coding department for assistance with the resubmission of claims requiring corrected diagnosis or procedure codes and as a resource for additional documentation or letters of inquiry and/or explanation, etc. Manages and researches status reports and the Aged AR to determine and resolve claim issues, denials, and overpayments. Works with insurance carriers and Privia to identify and address major claims issues and policy inconsistencies, escalating when necessary, for resolution. Provides the Business Office Manager with feedback regarding carrier issues and work progress status. Provides information to patients and/or insurance carriers regarding insurance coverage and payments, account balances, diagnoses, procedure costs, etc. Assists clerical andным and clinical staff with questions via telephone or email. Instructs and advises staff of insurance updates (maintains insurance reference sheets). Attends insurance company/computer training seminars. Reviews insurance company newsletters/manuals. Assists in maintaining supplies and equipment. Performs related work as required. Attends required meetings. Complies with Virginia Women's Center’s policies and procedures. Follows guidelines required by HIPAA, OSHA, and Red Flag regulations. Maintains appropriate attendance and punctuality as defined by Virginia Women's Center.
Requirements
- Minimum education of high school diploma or general education degree (GED)
- Minimum of one (1) year of medical billing experience required
- Knowledge of accounts receivable practices and medical business office procedures.
- Knowledge of office coding, billing, and operating policies and procedures.
- Knowledge of insurance carrier reimbursement procedures and practices.
- Knowledge of practice management software.
- Ability to examine documents for accuracy and completeness.
- Ability to prepare records in accordance with detailed instructions.
- Ability to communicate effectively and clearly.
- Ability to work effectively with co-workers as a team member.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, procedure manuals, and memos.
- Ability to make mathematical calculations, balance and reconcile figures, and make changes accurately.
- Ability to maintain strictest patient confidentiality.
- Ability to communicate with patients, insurance companies, & physicians to ascertain insurance information in a pleasant and helpful manner (includes hostile patients).
- Ability to maintain a high level of accuracy in computer data entry and posting of payments.
- Skill in grammar and spelling.
- Skill in maintaining departmental quality assurance and quality control standards.
Nice To Haves
- three (3) years of medical billing experience with a comprehensive knowledge of insurance is preferred.
- Related experience and/or training; or equivalent combination of education and experience will be considered.
Responsibilities
- Monitors and evaluates insurance reimbursements and requests review of questionable reimbursements on a claim-by-claim basis and by procedure code.
- Obtains accurate billing information from patients and insurance companies.
- Consults physicians and/or the coding department for assistance with the resubmission of claims requiring corrected diagnosis or procedure codes and as a resource for additional documentation or letters of inquiry and/or explanation, etc.
- Manages and researches status reports and the Aged AR to determine and resolve claim issues, denials, and overpayments.
- Works with insurance carriers and Privia to identify and address major claims issues and policy inconsistencies, escalating when necessary, for resolution.
- Provides the Business Office Manager with feedback regarding carrier issues and work progress status.
- Provides information to patients and/or insurance carriers regarding insurance coverage and payments, account balances, diagnoses, procedure costs, etc.
- Assists clerical and clinical staff with questions via telephone or email.
- Instructs and advises staff of insurance updates (maintains insurance reference sheets).
- Attends insurance company/computer training seminars.
- Reviews insurance company newsletters/manuals.
- Assists in maintaining supplies and equipment.
- Performs related work as required.
- Attends required meetings.
- Complies with Virginia Women's Center’s policies and procedures.
- Follows guidelines required by HIPAA, OSHA, and Red Flag regulations.
- Maintains appropriate attendance and punctuality as defined by Virginia Women's Center.
Benefits
- Health, dental, and vision insurance
- Health savings accounts (HSA) and flex spending accounts (FSA)
- 401k plan with employer contributions and match
- Paid time off and paid holidays
- Life insurance both employer-paid and voluntary
- Critical illness and accident insurance
- Annual employer contribution toward uniforms/scrubs
- Employer paid long-term disability benefits and comprehensive employee assistance program
- A variety of discount programs offered to employees
- Employee referral bonus and peer recognition programs
- Company-sponsored FUN events and community volunteer opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
