The Billing Specialist role requires critical thinking and attention to detail. This position is responsible for timely submission/follow-up on claims for all payer types and multiple specialties. The Billing Specialist's role focuses on maximizing revenue and cash flow by completing these tasks promptly and efficiently.
-
Resolve all charges in the Charge Review Work queue daily.
-
Resolve all assigned claims in the Claim Edit Work queue daily.
-
Resolve all payor rejections in the Follow Up Work queue within 10 working days.
-
Research and rebill/resolve all claim denials within 60 days of the date of the denial.
-
Research and rebill all claims with no response from the payor within 60 days of the date billed.
-
Monitor AR days for assigned departments, maintaining AR days no greater than 45 days.
-
Independently work to resolve claim denials to obtain payment.
-
Process appeals within the timely filing requirements of the payer contract.
-
Research credit balances to determine if a refund is required. Submit refund requests as needed.
-
Document all actions on accounts in the EHR with clear, complete, and accurate notes.
-
Contribute to the Billing Department team through positive attitude, respectful interaction, innovative ideas, efficiency, and ethical behavior.
-
Participate in educational activities and attend team meetings.
-
Maintain strict confidentiality; adhere to all HIPAA and PHI guidelines/regulations.
-
Must have 2+ years of revenue cycle experience working in a medical setting; knowledge of ICD-10, CPT Codes, and HCPC Codes.
-
Working knowledge of insurance payment regulations, including reimbursement, co-insurance, and deductibles, and contractual adjustments (Medicare, Medicaid, managed care, commercial insurance, and workers' compensation.
-
Possess a working knowledge of practice management systems and Microsoft Office.
-
Working knowledge of HIPAA and PHI regulations and compliance.
-
Strong interpersonal and communication skills to be able to work successfully in team-oriented environments.
-
High attention to detail and the ability to multitask.
-
Minimum Education Level: High School Diploma/GED.
-
2 years of experience in a medical office setting preferred.
EEO/AA: Milwaukee Health Services provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran by applicable federal, state and local laws. Our hiring and promotion policies focus on selecting the most qualified and capable candidates. Milwaukee Health Services complies with applicable state and local laws governing nondiscrimination in employment in every location where the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
