Medical Billing Specialist - Commercial Billing

Summary

We have the great privilege of helping patients and families re-build their lives. It's extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients "Ask for Mary," they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership, to clinicians and care providers.

• Maintain patient confidentiality as it is described in the HIPAA Privacy Act
• Submit timely, accurate and compliant insurance claims by utilizing the billing software
• Timely follow up with patients and insurance companies on all unpaid claims until resolution;
  • Understanding payor denial of claims reasons
  • The payor appeals process and sending necessary medical records
• Resolve credit balance accounts; this includes
  • Research and understanding of processed claims to determine why there's a credit balance
  • Work with insurance company to process refunds as appropriate
• Reviews explanation of benefits and benefits coverage to determine the best course of action. If needed for further clarification, contact insurance carrier
• Analyzes denial trends for staff/organizational education purposes
• Identify and report any billing system or payer issues to the Patient Financial Services System Analyst or Manager, as appropriate
• Research and identify new or updated billing regulations and notify the Revenue Cycle System Analyst and Manager
• Assist patients with payment options by explaining and offering alternative funding options
• Handle incoming patient calls/e-mails regarding patient accounts
• Assist in identifying additional educational opportunities for training of registration staff with billing regulations/requirements
• Responsible for reviewing clinician notes for appropriate documentation to ensure accurate billing
• Ensure payer and governmental agency regulatory and compliance requirements are consistently followed and applied
• Process insurance rejections, denial, or requests for additional information such as invoices and Medical Records in a timely manner
• Research online medical bulletins and policies, pricing and contractual issues
• Reviews clinical documentation, coding and claim to determine if the times and services provided to patients were applied correctly
• Prepares and mails written rationale of claim reconsideration request
• Tracks all denials within a database for reporting
• Maintains appropriate established timelines for follow up on outstanding appeal/reconsideration requests
• Collaborates with other Revenue Cycle Management and clinical departments to resolve claim issues as needed
• Perform other duties as assigned by the Manager

Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

• High school education or equivalent; associates degree preferred.
• Three to five years experience rehabilitation hospital medical billing.
• Knowledge of third party billing regulations.
• Proficient time management and organizational skills.
• Ability to problem-solve and work effectively as a team member.
• Effective written and verbal communication skills.

• Certification as Certified Professional Coder (CSC), Certified Coding Specialist-Professional (CCS-P), or Certified Medical Reimbursement Specialist (CMRS)

Levels:

• None (No specific requirements)
• Occasionally (Less than 1/3)
• Frequently (1/3 to 2/3)
• Majority (More than 2/3)

Remain in a stationary position:
Majority

Traverse or move around work location:
None

Use keyboard:
Frequently

Operate or use department specific…