Medical Billing Specialist

Reporting to the RCM Manager, this position will be responsible for the billing of all Banyan charges including but not limited to all inpatient and outpatient service lines. This includes multiple specialties and the ability to triage complex claim issues and AR trends. In addition, this role will also need to have extensive knowledge of billing, payer guidelines, clearinghouse functions, and benefit eligibility and coverage through multiple payers including Medicare and Medicaid, and a strong foundational knowledge of revenue cycle management.

Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Health System Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.

• Batching and submitting claims on a daily basis to the clearinghouse and payers to ensure timely submission of charges.
• Reviewing errors and rejections by clearinghouse and payers daily to resubmit claims for payment.
• Updating all patient accounts to correct inaccurate information i.e. demographics, eligibility dates, termination dates, and contract allowance and/or maximum.
• Managing the workflow of assigned accounts and meeting deadlines for filing to obtain maximum reimbursements.
• Ability to properly update and document all systems according to follow-up work.
• Audit and investigate any trends due to configuration issues within the Practice Mgmt System or clearinghouse.
• Ability to research payer policies, claim issues, and communicate to RCM management.
• Maintains knowledge of applicable Federal, State, and local laws and regulations, Standards of Conduct, as well as Health System policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Knowledge of payor benefits and coverage including Medicare, Medicaid, Managed Care, Commercial, and Dual plans.
• Ability to multi-task and meet weekly and monthly deadlines.
• Assist in month end projects and processes.
• Respond to all inquiries from patients, physicians or departmental customers (both internal and external) within 1 business day of initial request.
• Identify, report, and communicate accounts receivable trends to RCM management.
• Small- and large-scale projects for the RCM department.

Associate degree preferred. Work experience may substitute degree (i.e., 2 years of experience for 1 year of education)

• Advanced knowledge of medical and insurance terminology
• Advanced Knowledge and demonstrated proficiency in medical insurance plans, billing and regulations, and manage care plans.
• Strong ability to multi-task and work under pressure to meet deadlines.
• Medical insurance collections experience in a healthcare setting.
• Working knowledge of applicable Federal, State, and local laws and regulations desired
• Working knowledge of CPT and ICD-10 codes as they relate to financial clearance.
• Able to obtain payer specific details, as necessary, to ensure accurate coordination of benefits.
• Experience working with multiple payer websites and portals.

• Minimum 2-3 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience
• Experience in behavioral health billing and/or collections preferred.

Job Type: Full-time

100% Paid Health Insurance (Employee Base Plan)

100% Employer-Paid Basic Life Insurance

Dental, Vision, Short-Term Disability (STD), Long-Term Disability (LTD), Secondary Health Insurance, and Other Voluntary Benefit Plans

403(b) Retirement Plan with Employer Matching

Student Loan Forgiveness Opportunities

Potential HRSA Student Loan Repayment for eligible licensed positions*

* Certain licensed positions working in qualifying outpatient settings may be eligible for the HRSA National Health Service Corps Loan Repayment Program
. Eligibility is subject to HRSA requirements and position responsibilities and will be confirmed during the hiring process.