Billing Specialist Jobs

About The Position

Requirements

• High school diploma or GED equivalent.
• Previous experience in medical billing or collections, with progressively increasing complexity and responsibility.
• Knowledge of general office procedures and use of office equipment.
• PC skills and demonstrated proficiency in Microsoft Word, Excel, and medical billing software.
• Prior experience using email and the web.
• Ability to pass a pre-placement drug test and background screen.
• Working knowledge of HCPCS, CPT, ICD-9 and ICD-10 codes, medical terminology, and clinical documentation.

Nice To Haves

• Some college preferred.

Responsibilities

• Act as a patient advocate by obtaining information and support for claims processing and discussing outstanding balances and resolution options.
• Analyze adverse billing, collection, and payer trends; report or present findings to management and suggest solutions.
• Assist with special projects related to payer issues or collections shortfalls.
• Contact insurers to obtain timely payments and escalate issues to supervisors or grievance departments as appropriate.
• Categorize and quantify payer payment issues for resolution and management reporting.
• Maintain customer focus and communicate professionally with patients, first responders, facilities, PHI agencies, entities, insurers, and attorneys.
• Apply knowledge of payer fee schedules, enrollment requirements, and PHI payer and facility contracts.
• Handle payment-in-full negotiation offers, overpayment reviews and approvals, correspondence actions, insurance types and classes, and related work in compliance with company policies.
• Draft correspondence to patients and payers, including first-level appeals for technical denials, and identify accounts for referral to the Appeals Department.
• Handle patient calls and conduct financial reviews for charity-program eligibility, payment plans, discount negotiations, and patient complaint resolution.
• Work cooperatively within the team and throughout the PFS department.
• Organize and prioritize work using online tools, required systems, and software to meet production goals.
• Participate in ongoing training and take on increased responsibilities and duties.
• Perform financial screening for payment-in-full offers, payment plans, and the company's charity program, following billing policies and procedures.
• Conduct in-depth account reviews, including skip tracing, correspondence research, secondary claims billing, payment review, contractual adjustments, and updates to insurance or demographic information.
• Identify, obtain, and confirm insurance coverage, including prior authorization, third-party liability, and coordination of benefits.
• Provide leadership and serve as a resource to management by assisting, training, and supporting PFS Billing Staff.
• Research, evaluate, and communicate payer-specific billing policies, guidelines, and statutory regulations to the team.
• Monitor and track claims and correspondence, and prioritize follow-up to meet production standards.
• Review patient accounts for appropriate handling regardless of age, status, or payer.
• Interpret explanations of benefits to assess contractual compliance, payment accuracy, patient responsibility, denials, and reductions in coverage, and follow up as needed.
• Take direction, coordinate projects, and prioritize assignments individually and at the departmental or team level.
• Understand payer billing requirements, help ensure claims are accurate before submission, and train staff on billing requirements for new and established payers.
• Apply insurance regulations and guidelines, including CMS guidelines, when discussing slow payments, underpayments, and denials with payers and ensuring compliant claim processing.
• Comply with company HS&E policies and procedures and support company Safety Management Systems activities.
• Understand and visibly support Destination Zero.
• Perform other duties and responsibilities as assigned.

Benefits

• Sign-on bonus up to $7,500