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Job Type
Full-time
Description
POSITION DESCRIPTION:
The Billing Specialist is responsible for timely, accurate and comprehensive billing of all provider services utilizing appropriate CPT, HCPCS and ICD-10 diagnosis codes. The individual prepares and submits clean claims to Medicare, Medicaid, Commercial insurance carriers, and Self-Pay patients and works rejections.
DUTIES AND RESPONSIBILITIES:
- Submits claims to payers based on review of medical records and in accordance with Medicare, Medicaid, and Commercial insurance guidelines as well as FHCSWF policies and procedures.
- Reviews information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information to ensure clean claim submission.
- Enters charges accurately and expeditiously to ensure proper records handling and fast payment.
- Timely filing of insurance claims to clearinghouse or individual insurance companies electronically or via paper.
- Review and correction of claim edits within 24 hours of being received from clearinghouse and internal claims scrubber.
- Initiates private pay collections after insurance cancellation, denial or other issue and answer patient questions on patient responsible portions, copays, deductibles, write-offs, etc.
- Performs self-pay patient billing.
- Prepares and sends patient statements for charges not covered by insurance.
- Other duties as assigned.
Requirements
KNOWLEDGE:
- Demonstrated knowledge of Medicaid, Medicare, and Commercial Insurance rules and procedures in a managed care plan environment
- Medical terminology, CPT, HCPCS and ICD-10 coding and modifier usage
- Understanding of FQHC billing procedures and Sliding Fee Schedules a plus
- EHR systems expertise, preferably with Intergy or other ambulatory care facility-based system
- Understand and adhere to all HIPAA guidelines
- MS Office Suite (Excel proficiency)
- Alpha-Numeric data entry
SKILLS AND ABILITIES:
- High School or Equivalent (Associates Degree preferred)
- 2 Years Medical Billing experience
- CMRS, CPB, or CPC credentials a plus
- Attention to detail with strong documentation, analytic and problem-solving skills
- Ability to multi-task in a fast-paced environment
- Strong interpersonal written & verbal communication skill