Billing Specialist II

The Billing Specialist supports the complete and timely collection of revenue for assigned groups by performing accurate coding and entry of patient and charge information into the billing system. This position will track all high dollar claims from charge entry to payment and will resolve complex carrier issues. The individual actively follows up on outstanding complex claims/or charges.

Essential Duties and Responsiblities:

• Reviews and resolves complex issues that result in payer denials, including appeals, coding corrections, medically necessity rules and other related functions.

• Assists the auditor in reviewing notes for medical necessity.

• Works with the authorization department to resolve authorization issues with complex procedures.

• Runs and maintains tracking logs to track complex high dollar procedures and report the results to the billing department management team.

• Contacts the various Provider Service Representatives to resolve repetitive payment issues

• Acts as a resource for the Billing Staff for complex issues.

• Analyzes and resolve billing issues, keeping A/R to no more than 10% over 60 days.

• Processes daily correspondence, claim status, handle denials, appeals and re-bills.

• Answers billing questions and inquiries from patients and internal staff.

• Updates patient files with address changes, contact information changes, etc., as needed.

• Reviews all policy changes on a regular basis and informs supervisor and charge entry specialist of such changes.

• Efficiently navigates assigned insurance companies' proprietary websites to find policies, research payments, etc.

• Keeps supervisor apprised of matters regarding accounts receivable.

• Responds to requests from billing company in a timely fashion.

• Researches denials and submits correct claims/medical documentation.

• Reviews and manages claims within the work dashboard hold buckets for resolution.

• Creates, maintains and updates reports, as directed.

• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.

• Helps train new revenue cycle staff.

• Collects and reviews end of day reports.

• Checks work e-mail on a regular basis throughout the workday.

• Participates in and complete all required trainings and in-services.

• Performs other duties as assigned.

Minimum Qualifications:

• High School Diploma, or equivalent WITH a minimum of five (5) years related experience; OR an equivalent combination of education and/or experience.

• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).

• Must have excellent written and oral communication skills, including exceptional customer service.

• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.

• Must be able to work individually as well as within a team.

• Must be able to follow both verbal and written instructions.

• Must be able to work a flexible schedule.

• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.

• Must be able to multi-task and prioritize.

• Must demonstrate extreme attention to detail.

• Must possess strong organization skills.

• Must be able to problem solve and use reasoning.

• Must be able to meet predefined quality standards.

• Must maintain and project a professional attitude and appearance at all time.

• Must have a working knowledge of CPT and ICD-10 coding rules.

• Must have a solid foundation of insurance knowledge and guidelines for third party payers.

• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.

• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Two (2) years experience working with an Electronic Medical Record (EMR).

• Medical Billing Certification

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employees home, work assignments could be in any of the Companys locations.