Provider Side Medical Billing Specialist

Provider Side Medical Billing Specialist

Minneapolis, MN, USA

Posted Tuesday, July 6, 2021 at 4:00 AM

Provider Side Medical Billing Specialist

Activ Style, an Adapt Health Company in NE Minneapolis specializes in the supply of home delivery of medical products. We offer personalized service, uncompromising commitment to quality, and superior customer service. We are passionate about making our customers' lives easier and hire only the most talented and compassionate individuals to make a profound impact on the quality of our customers  lives.

We are dedicated to pursuing better and use technology, process and the power of our national network to do so. We have a relentless commitment to using innovation to transform the durable medical equipment industry, break the status quo and provide the best quality care.

Position Summary: The Provider Side Medical Billing Specialist is responsible for proper billing of and collections from third party insurance companies. This position will be expected to review reports, correct denied claims, and work with multiple insurance plans throughout the US.

Essential Functions and

Job Responsibilities:

• Review claims prior to claim submission and edit as needed per the payer’s requirements
• Analyze and update claims on hold to ensure hold reason is rectified before it is submitted
• Review tied items and HCPCS codes against known requirements to ensure accurate processing and payment of claims
• Work clearinghouse or payer level rejections to resolve claim issues
• Work necessary reports to ensure that claims are being followed up on to maximize receivables
• Review client’s insurance and determine next proper steps of account following the payer’s guidelines
• Learn and obtain understanding of refunds, credits and adjustment procedures
• Document accounts properly with actions requested, taken, or with pertinent information for future reference
• Review assigned payer requirements on a consistent basis for any fee schedule updates, in addition to reviewing payer notifications received via mail, email, or websites and alerting supervisor of any changes
• Communicate and collaborate with team members and other departments to resolve internal and external customer concerns via email, fax or phone
• Perform all duties and responsibilities in compliance with all State, Federal, and Company policies
• Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends
• Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer contracts to ensure accurate billing and timely payment is received
• Responsible for entering data in an accurate manner into databases including payer, authorization requirements, coverage limitations and status of any requalification
• Collaborates with physician offices, Adapt Health sales and support staff to ensure timely receipt of documentation as well as educating, as necessary
• Identify trends and provide feedback and education to internal and external customers on compliant documentation requirements for services provided
• Performs other related duties as assigned

Competency,

Skills and Abilities:

• Decision Making
• Analytical and problem-solving skills with attention to detail
• Strong verbal and written communication
• Proficient computer skills and knowledge of Microsoft Office
• Ability to prioritize and manage multiple tasks
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction

Education and Experience Requirements:

• High School Diploma or equivalent
• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance

Physical Demands and…