Who We Are
Compleat KiDZ / Kare Partners is seeking an experienced Senior Medical Billing Specialist to join our growing team in our Belmont, NC office. If you have at least 3-5 years' experience working in the medical billing world, possess a positive, problem-solving attitude, and are ready to work with a supportive, dynamic team-we want to hear from you. Please note, this is not a remote position.
Basic Accountability Statement
The Senior Medical Billing Specialist must demonstrate an exceptional understanding of billing-related functions within their functional areas. As a senior-level specialist, you will need a positive and supportive attitude, plus a drive to contribute to the overall success of Compleat KiDZ / Kare Partners.
The Senior Medical Billing Specialist will be responsible for working closely with the Medical Billing Team to ensure payment is secured for all services by timely filing of secondary/tertiary insurance billings, follow-up, denials, reconsiderations, and appeals until all claims are fully adjudicated.
Duties and Responsibilities
- Act as point of contact for eligibility and third-party billing questions and processes.
- Responsible for the processing of NC Medicaid, Medicare Part A & B, and private insurance claims.
- Review all claims for completeness, reasonableness of charges, appropriateness of billing codes, and payer information.
- Review referrals and pre-authorizations as required for payment of outstanding dates of service.
- Ensure claims meet regulatory requirements.
- Pursue timely collection of each claim using thorough follow-up efforts appropriate to each payer, and follow up on insurance claim denials and exceptions or exclusions.
- Read and interpret insurance explanations of benefits.
- File appeals when appropriate to obtain maximum reimbursement.
- Perform insurance verification.
- Recheck eligibility and benefits verifications for outstanding dates of service.
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Conduct billing utilizing the most efficient resources to secure timely payment of open claims or invoices, giving priority to electronic solutions.
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Review and work from developed aging and denial reports for resubmission of claims to the correct insurance carrier.
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Review patient bills for accuracy and completeness and obtain any missing information.
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Make necessary arrangements for medical records requests, completion of additional-information requests, etc., as requested by insurance companies.
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Provide timely responses to inquiries from insurance companies, patients, and providers.
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Regularly meet with the VP of Revenue Operations to discuss and resolve reimbursement issues or billing obstacles.
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Regularly attend weekly/monthly staff meetings and continuing-education sessions as requested.
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Contact insurance companies by phone and/or submit letters of appeal in an attempt to collect outstanding payment and obtain maximum reimbursement.
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Follow up on unpaid claims within the standard billing-cycle timeframe.
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Check each insurance payment for accuracy and compliance with contract discount.
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Identify and bill secondary or tertiary insurances as needed by the company.
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Review all accounts for insurance or patient follow-up.
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Research and appeal denied claims.
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Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
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Perform additional duties as requested by Management.
Associate degree or above.
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Minimum of three years of experience in a medical billing specialist role. Major bonus points if you have experience with Clinicient.
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Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
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Strong process and analytical skills.
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Experience using coding - ICD-10 and CPT codes - as well as medical billing forms UB-04 and CMS-1500.
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Basic computer experience; familiar with the Microsoft Office Suite.
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Excellent written, verbal, and organizational skills.
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Ability to adapt to changing organizational needs.
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Ability to manage relationships with various insurance payers.
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Ability to meet strict deadlines.
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Responsible use of confidential information and understanding of HIPAA compliance.
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Perform to company standards of compliance with policies and procedures.
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Ability to multi-task and work courteously and respectfully with fellow employees, clients, and patients.
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Working knowledge of North Carolina Medicaid billing and the NCTracks system.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; use hands to finger, handle, or feel; and reach with hands and arms. Lifting, pushing, and pulling are also required.
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. The above is intended to describe the general content and requirements for the performance of this position and is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.
Compleat KiDZ offers a competitive compensation and benefits package including medical/dental, vision coverage, HSA, STD, LTD, life insurance, EAP, a company-matched 401(k), and paid vacation/holidays.
Compleat KiDZ is proud to be an Equal Opportunity Employer and is committed to creating an inclusive workplace where every team member can thrive.
