Billing Specialist

BILLING DEPARTMENT SPECIALIST CHARACTERISTICS OF WORK

Assist the Data Processing Department and the Billing Coordinator by performing assigned duties as necessary. Primary duties include entering data for accounts receivable, client statistics, client billings, printing reports and journals, etc. See below for full job responsibilities.

• Resolve, call and/or appeal a defined number of accounts per day as instructed by leadership.
• Complete initial reviews as assigned.
• Draft appeals and letters to insurance companies.
• Make proper notations in system on all accounts.
• Understand and utilize payer contracts and provider manuals when disputing denials.
• Calculate expected claim reimbursement.
• Follow up on all appeals, claims, letters, or other documentation with the insurer.
• Follow up on all payments at the time an overturn is received.
• Demonstrate an understanding of office workflow by completing necessary required fields correctly.
• Use available resources appropriately, including but not limited to training materials, shared drive, team meeting notes, etc.
• Maintain worklist through daily audits and the open task report.
• Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.
• Address all follow ups promptly according to priorities provided by leadership.
• Ensure claim and appeal time frames are met.
• Obtain prior approval from a Lead, Supervisor, or Manager for all modifications to a UB-04; including, but not limited to, additions, changes or removals to/from the original claim provided by the facility.
• Follow all HIPAA guidelines in accordance with Employee Handbook.

• 1-2+ years related experience in healthcare claims and/or equivalent combination of education and experience
• 1-2+ years of experience with appeals and denials
• Medical billing experience
• General knowledge of claims forms and Explanation of Benefits forms
• Experience with Electronic Medical Records
• Knowledge of Medicare and Medicaid claims

Bachelor’s Degree or High School Diploma or General Education Development equivalency and at least one (1) year work experience. Must have a valid Mississippi driver’s license and pass a criminal background check.

Billing Coordinator, Director of Strategic Planning & Development

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