Billing Specialist

Brief Description

JOB SUMMARY:

Responsible for timely and accurate submission of claims daily in the Rejected or Approved Failed status.

Job Specific Duties And Responsibilities

• Collects and reviews all patient insurance information needed to complete the billing process.
• Ensures that all necessary insurance info is collected to process the claim in a timely manner as required by all third party payors. This includes demographics, authorizations, NDC, NPI, diagnosis codes, modifiers.
• Assigns claims needing changes in diagnosis codes, modifiers, CPT, or HCPCS to coding agency.
• Assigns claims needing review to other appropriate team members
• Transmits daily all electronic claims to third party payors. Researches and resolves any electronic claim delays within 24 hours of exception report print date.
• Submits paper claims and supporting documentation when required by payors.
• Works the rejections caused by the system edits
• Works the secondary claims when they don’t match primary EOB
• Alerts Transact of drug replacement claims
• Maintains confidentiality in regards to patient account status clinic/corporation.
• Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
• Perform other duties as assigned.
  
  

EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION: High School Diploma or equivalent

EXPERIENCE, KNOWLEDGE, SKILLS And ABILITIES

• Minimum of two years medical clinic or insurance experience
• Excellent computer and other basic office equipment skills
• Skilled in gathering, interpreting, and reporting insurance information
• Knowledge of medical terminology, insurance practices, and office procedures
• Knowledge of grammar, spelling, and punctuation to type from draft copy and review/edit reports/correspondence
• Skilled in time management and organization
  
  

Reasoning Ability

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, or schedule form.
  
  

Interpersonal Skills

• Must interact and communicate both verbally and in written form.
• Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.
  
  

Physical Demands

• 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 regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.
  
  

Work Environment

The work environment described here are representative of those an employee encounters while performing the essential functions of this job. This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

Comments

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.