Billing Specialist I

Billing Specialist Job Description

Position Details

Job Title: Billing Specialist

Job Title Description: Billing Specialist I

Job Type: Staff

FLSA Type: Non-Exempt

Job Family: Revenue Cycle

Reports To: Revenue Cycle Manager.  Daily assignments or direction may occasionally be provided by the Audit Compliance and Coding Manager, Director of Revenue Cycle, Director of Finance, Office Manager, Human Resource Manager or Director, Chief Operating Officer, Director of Operations, or the Physicians.

Interfaces With: Staff of Ohio Gastroenterology Group Inc and Central Ohio Endoscopy Center LLC, collection agencies, hospital staff, insurance companies, referring physicians, and patients

Work Location: Chatham Office

Job Overview:  This position is primarily responsible for reviewing, editing, and submitting clean claims in a timely manner for medical services provided in a medical office setting.

Key Responsibilities

Core Responsibilities

• Accepts and reviews patient encounters for accuracy and follows standard quality review procedures on each encounter posted
• Collaborates with providers, referring physician offices, nursing, scheduling, and other internal resources to understand and capture relevant billing information
• Enters or edits information necessary for insurance claims such as patient, insurance ID, payer, provider information, diagnosis, treatment codes and/or modifiers
• Verifies patient benefits eligibility and coverage
• Identifies missing or incomplete charge data and works to obtain and process in a timely manner
• Prepares and submits clean claims to insurance carriers either electronically or on paper as determined by the carrier
• Resolves front-end edits generated from the system, clearinghouse or payer, and resubmits claims for processing
• Identifies key trends and works with the Revenue Cycle Lead or Revenue Cycle  Manager to resolve issues
• Other duties as assigned.

Additional Responsibilities

• Follow up with insurance company on unpaid or rejected claims. Resolve issue and re-submits claims
• Assists with inquiries regarding claims and non-covered charges
• Attend meetings and training sessions
• Maintain confidentiality of patient and financial information by utilizing HIPAA guidelines and regulations
• Maintain knowledge and adhere to related governmental regulations and all policies set forth by Ohio Gastroenterology Group Inc and its related parties

Knowledge, Skills, and Abilities

• Demonstrate a professional approach to daily responsibilities while contributing to a positive, team-oriented work environment
• Knowledge of third-party payers and prior-authorization requirements
• Comprehensive understanding of medical terminology and procedures
• Working knowledge using ICD-10 and CPT codes
• Working knowledge of medical billing for office visits
• Proficient use of office equipment, such as copier and fax machine, phones, etc.
• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical records systems.
• High attention to detail and the ability to multi-task.
• Strong time management skills
• Ability to work independently with minimal supervision and to manage multiple priorities.
• Strong written and verbal communication skills
• Ability to effectively communicate with a variety of people under stressful circumstances.
• Neat appearance, professional demeanor and pleasant voice
• Fluent in English

Required Qualifications

• Must have high school diploma or equivalent
• One (1) or more years of medical billing, coding, and/or AR Follow-up

Preferred Qualifications

• Experience with gGastro/ModMed
• Experience in GI

Physical Requirements

• Must be able to bend over (frequent), climb stairs (frequent), sit (frequent), stand (frequent), stoop (frequent), walk (frequent) and type on keyboard (frequent). 

Work Environment

• Minimal medical office exposure that may require contact with adult patients
• Office workstation environment with numerous employees