Medical Billing Specialist - Nurse Practitioner Billing

The Medical Billing Specialist for Nurse Practitioners is responsible for processing and mailing/transmitting claims, tracking claims, monitoring authorization and eligibility of payor benefits, managing the collections process and posting cash receipts.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Extract and verify billing information from medical records through VISION software

• Contact patients by phone and/or mail regarding accounts

• Ensuring collection of past due balances; follow up as needed

• Ensure all patient demographic and insurance is accurate prior to submitting claims to insurance companies

• Answer patient account inquiries; assists establish alternative payment plans when necessary

• Maintain patient account records; settle third party payer issues as required

• Receive and review Daily Reconciliation Review (DAR) document for accuracy; enter charges into Practice Management System (PMS)

• Prepare and review patient statements prior to release through PMS

• Ensure timely filing of all Medicare, Medicaid, and third-party insurance claims; reconcile all payments with related charges and adjustments

• Balance daily charges; reconcile with reports within PMS

• Perform follow-ups on all claims submitted in timely intervals established by revenue cycle manager

• Collaborate with revenue cycle manager and payers on denials/rejections

• Post all third-party payments and applicable contractual allowances to patient accounts

• Work closely with practice location representatives to ensure proper insurance verifications and authorizations are obtained

• Other duties as assigned

JOB REQUIREMENTS:

• Comply with applicable legal requirements, standards, policies and procedures including but not limited those within the Corporate Compliance Program, Corporate Code of Conduct, HIPAA, and Federal False Claims Act

• Report concerns and suspected incidences of non-compliance immediately to the Chief Compliance Officer

• Communicate professionally with patients and guarantors regarding balances or account information

• Participate in required orientation and training programs

• Cooperate with monitoring and audit functions and investigations

• Participate in process improvement responsibilities

• Meet productivity goals

• Successful completion of required training

• Handle multiple priorities effectively

REQUIRED SKILLS:

• Problem solving skills to manage a variety of concrete variables

• Effective verbal and written communication skills

• Ability to interpret instruction presented in variety of situations

• Strong organizational skills; ability to manage multiple projects simultaneously

• Proficiency with Microsoft Word, Excel, PowerPoint, and Internet Explorer

• Ten key speed and accuracy

• Strong written and verbal communication skills

• Proficient knowledge of medical billing and coding

• Solid knowledge of medical terminology

Required Computer Software/Equipment used:

• Various operating systems

• Standard office equipment

• Microsoft Suite applications

• Desktop or laptop computer

REQUIRED QUALIFICATIONS:

• Education:

o High school diploma or equivalent required

o Associates degree preferred

• Experience:

o Three (3) years' experience in medical insurance billing for nurse practitioners is required

o Experience billing for nurse practitioners in a long-term care setting preferred

SUPERVISORY RESPONSIBILITIES:

• Does not have supervisory responsibilities

WORKING CONDITIONS:

• Audio-Visual: Good

• Hearing: Good

• Ability to lift to 5 pounds

• Subject to standing, walking, sitting, and use of hands

• Work is typically performed in a standard office environment; well-lit; comfortable temperature-controlled

• Above-average conversational noise is frequent

• Position may require flexible hours, unscheduled overtime or occasional week-end work

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EEO

This employer participates in E-Verify.