Description:
SUMMARY OF RESPONSIBILITIES
The position of Medical Billing Specialist is responsible for working and tracking high level accounts receivables, radiology prior authorizations, and mailing medical records and appeals.
Requirements:
ESSENTIAL FUNCTIONS
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Maintains a comprehensive knowledge of the policies of all insurance carriers, including Medicare and Medicaid.
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Confirm that verification of insurance, prior authorization, and valid insurance referral have been obtained.
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Processes prior authorization requests for imaging, prescriptions, and procedures. This may include receiving requests via EMR messages from provider teams, faxes, or telephone calls from pharmacies, or working the schedule to review where authorizations are needed. Requests authorizations by speaking directly with insurance company representative by phone or via internet portals. Expedites urgent requests.
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Ensures that accurate and required clinical documentation is in patient charts to send to insurance carriers upon request.
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Uses Clinic Forms and Patient Notes to document prior authorization process and status.
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Work accounts receivables on high level procedures as assigned by supervisor.
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Responsible for providing timely and accurate billing and collections for assigned accounts receivable.
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Must be able to assess accuracy of claims and perform corrections as needed to ensure timely payments.
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Ability to interpret payer contract terms as they relate to billing exceptions.
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Accurate documentation and timely filing/follow up to maximize reimbursement.
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Ability to print and mail medical records and appeals to insurance carriers.
CORE COMPETENCIES
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Comprehensive knowledge of medical and insurance terminology.
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Excellent oral and written communication skills.
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Excellent skills in customer service and communications.
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Knowledge of current medical terminology to communicate with physician, staff, and patients.
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Strong telephone communication skills.
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High level of attention to detail.
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Strong organization, filing, and time management skills.
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Basic computer literacy and typing.
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Reliable attendance.
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Patient focused.
REQUIRED EDUCATION, EXPERIENCE, AND/OR CERTIFICATIONS
This position requires a high school diploma or equivalent and four (4) years’ experience in the healthcare field. Experience with medical billing, coding, and accounts receivable is preferred.
WORKING ENVIRONMENT AND PHYSICAL DEMANDS
This is a full-time position. Days and hours of work are expected to include 8:00 a.m. to 5:00 p.m. (Monday through Thursday) and 8:00 a.m. to 12:00 p.m. (Friday). Occasional overtime may be required. The position operates in a professional office environment and the incumbent, in the course of performing this position, spends time writing, typing, speaking, listening, driving, seeing (such as close, color and peripheral vision, depth perception and adjusted focus), sitting, walking, standing, and reaching. The incumbent may operate any or all the following standard office equipment including but not limited to multi-line telephone system, postage meter, facsimile machines, calculator, photocopy machine, computer/printer, and coffee maker. The work environment characteristics and physical demands described here are representative of those an employee encounters while performing the essential functions of this job..
SUMMARY OF RESPONSIBILITIES
The position of Patient Financial Counselor is responsible for contacting patients to schedule procedures, communicate out-of-pocket costs, payment requirements and options with patients, and processing patient payments.
