Medical Billing Specialist

Clinical Pathology Laboratories, Inc. Poland , OH 44514

Posted 6 days ago

Job Functions, Duties, Responsibilities and Position

Qualifications:

Responsible to:

Revenue Cycle Manger

Duties:

  • Review requisitions daily for accuracy regarding correct insurance, correct demographics and correct classification as to Insurance or Client Bill treatment.

  • Review diagnosis codes on all patient orders, and verify medical necessity requirements are met, where applicable.

  • Follow-up with PMC on any codes in question.

  • Assist with prior authorization requirements for all applicable tests.

  • Assure that all insurance claims are filed, worked, and resolved to the timely filing deadlines of various payers including performing all follow-up on claim denials with timely resolution achieved for all appeals, corrected claims and eligibility issues.

  • Review all pending patient bills before they are released to ensure that all efforts have been exhausted to minimize patient liabilities and verify that applicable insurance benefits are used.

  • Perform secondary claim submissions related to PMC's patients' insurance benefits.

  • Submit and verify all PMC patient refunds. Work with patients on-site or via phone to assist with billing questions/concerns.

  • Collaborate with PMC's billing team to address any client or patient bill questions or concerns.

  • Function as the direct point of contact for all billing matters between PathLabs and PMC.

  • Establish and maintain a collaborative and supportive relationship in the spirit of teamwork between PathLabs and PMC's staff in the best interest of patient care and customer satisfaction.

  • Perform all communication timely to the PMC practice and patients related to work within the role of Billing Specialist.

  • Prepare, review and assure accuracy of all monthly client billing for PMC in format desired by PMC as to each referring physician, and perform appropriate reclassification and follow-up as needed for PMC's satisfaction.

Other Responsibilities:

  • Adhere to all Company policies, including human resource and departmental policies. Attend training such as Annual Safety and Compliance Training, ICD-10 Coding and other training as required by Company policy.

  • Responsible for observing the law, meeting the requirement of the Corporate Compliance Plan and preventing, detecting and reporting unethical or illegal conduct that does not meet compliance standards.

  • Responsible for maintaining patient confidentiality including test results, what tests are performed or ordered, the fact that a patient has even had a medical service and billing-related and account issues.

  • Responsible for complying with HIPAA regulations, as is applicable with our business.

  • The above list of duties is intended to describe the general nature and level of work performed by employee assigned to this classification. It is not to be construed as an exhaustive list of duties, nor is it intended to limit the right of any supervisor to assign, direct, or control the work of employees under his/her supervision.

Qualifications:

  • Medical billing experience 3+ years or equivalent.

  • Excellent customer service skills.

  • Excellent verbal and written communication skills.

  • Knowledge of:

ICD-10 and CPT codes

Modifiers

Medical Necessity

EOB (Explanation of Benefits)

Payment Posting

Working Rejection and Aging Reports

Trending Patterns

Patient Collections

  • Data entry skills

  • Customer service skills

  • Works well independently and self motivated

  • Must be able to handle multiple tasks with efficiency and work well in a fast pace environment.

  • Analytical skills.

  • Ability to interact and be responsive to management and local inquiries as to AR/collections/billing activities, etc.

Relational Skills:

  • Represent Pathology Laboratories in a professional manner while effectively and courteously communicating with patients, management and co-workers.

  • Work in close cooperation with Revenue Cycle Manger, PMC Staff, Billing Department, Patients, Insurance Companies, and all other departments in Company.

  • Maintain a professional manner and appearance.

Aptitudes:

  • Intelligence-ability to understand instructions, reason and make judgement. Requirement: High

  • Learningability to learn and understand the changes made in programs and processes to keep department up to date. Requirement: High

  • Verbal-ability to understand meaning of work, ideas associated with them and their effective use. Requirement: High

  • Numerical-ability to perform arithmetic operations quickly and accurately. Requirement: High

  • Clerical Perception-ability to perceive pertinent details and verbal or tabular material. Requirement: High

  • Motor Coordination-ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Requirement: High

  • Finger-Dexterity-ability to move fingers easily and skillfully. Requirement: High

  • Manual Dexterity-ability to move hands easily and skillfully. Requirement: High

  • Color Discrimination-ability to perceive similarities and differences in color. Requirement: Moderate

Physical Demands:

  • Medium work lifting up to 50 pounds and/or carrying objects weighing up to 25 pounds.

Working Conditions:

  • Routine duties involve primarily computer entry resulting in repetitive typing and multiple screen viewing.

  • Answering multi telephone calls relating to clients, patients, insurance companies, and etc. with making a full day of sitting in the same position and performing the repetitive procedures.

  • Multi-tasking throughout the work day.

Scheduled Weekly Hours:
40

Work Shift:
1st Shift (United States of America)

Company:

Sonic Healthcare USA, Inc

Sonic Healthcare USA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.


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Medical Billing Specialist

Clinical Pathology Laboratories, Inc.