Medical Billing Specialist

Job Description

Billing & Invoicing work is focused on designing and ensuring compliance with billing and invoicing processes including:

• Information verification (e.g., ensure accuracy of billing information, negotiated terms and compliance with current legislation)
• Monitoring customer accounts (e.g., ensure payments made on time, report on overdue accounts, etc.)
• Resolving billing discrepancies (e.g., investigate and resolve billing & invoicing errors, recommend process improvements to avoid future errors, etc.)
• May include collections activities

Requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. May require the following proficiency:

• Works under moderate supervision.
• Problems are typically of a routine nature but may at times require interpretation or deviation from standard procedures.
• Communicates information that requires some explanation or interpretation.

• Responsible for claim review and submission to Medicare, Medicaid, commercial and private insurance payers. Verifies accuracy and completeness of all required information prior to submission.
• Follows up with insurance companies on unpaid or rejected claims. Resolves issues and resubmits claims.
• Reads and interprets insurance explanation of benefits. Maintains specialized knowledge in insurance processes and guidelines, including authorizations and limitations.
• Investigates insurance claim denials, exceptions, or exclusions. Takes necessary action to resolve claim and payer issues in an effort to recover proper reimbursement.
• Provides customer service relating to all billing inquiries and complaints. Able to explain insurance processes, benefits, and exclusions. Follows HIPAA guidelines in handling customer information.
• Performs other billing duties as requested by the Billing Supervisor, Billing Manager, or Director of Billing.

• Must have a high school diploma, college degree preferred, not required.
• Six months to one year of related experience and/or training; or equivalent combination of education and experience.
• Proficient in use of computers and software including, but not limited to: practice management software, word processing and spreadsheet applications.
• Detail oriented with ability to multi-task.
• Manages one’s own time with minimal supervision.
• Strong mathematics and problem-solving skills.
• Seeks and shares pertinent information related to insurance or internal processes.
• Communicates effectively both verbally and in writing to convey and receive information.
• Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Self-evaluates performance to make improvements or take corrective action. Consider the relative costs and benefits of potential actions to choose the most appropriate one.
• Use equipment, facilities, and materials appropriately as needed to do certain work.
• This position must commit to 9 months in the role before applying for alternative roles within the organization. Exceptions must be approved by Department leadership.

• Regularly required to sit, stand, walk, and occasionally bend and move about the facility.
• Infrequent light physical effort required.
• Occasional lifting under 10 lbs.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Work performed in an office environment.

• Not Applicable

• Full-time

• Accounting/Auditing

• Medical Equipment Manufacturing