Medical Billing Specialist

Location: Ladue

Our Medical Billing Specialists ensure efficient filing and resolution of insurance claims; acting as liaison between doctors, insurance companies, and patients.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Monitors and evaluates insurance reimbursements and requests review of questionable reimbursements on a claim-by-claim basis and by procedure code.

Obtains accurate billing information from patients and insurance companies.

Consults physicians and/or the coding department for assistance with the resubmission of claims requiring corrected diagnosis or procedure codes and as a resource for additional documentation or letters of inquiry and/or explanation, etc.

Manages and researches status reports and the Aged AR to determine and resolve claim issues, denials, and over payments.

Works with insurance carriers and Privia to identify and address major claims issues and policy inconsistencies, escalating when necessary, for resolution.

Provides the Business Office Manager with feedback regarding carrier issues and work progress status.

Provides information to patients and/or insurance carriers regarding insurance coverage and payments, account balances, diagnoses, procedure costs, etc.

Assists clerical and clinical staff with questions via telephone or email.

Instructs and advises staff of insurance updates (maintains insurance reference sheets).Attends insurance company/computer training seminars.

Reviews insurance company newsletters/manuals.

Assists in maintaining supplies and equipment.

Performs related work as required.

Attends required meetings.

Complies with Virginia Women's Center’s policies and procedures. Follows guidelines required by HIPAA, OSHA, and Red Flag regulations. Maintains appropriate attendance and punctuality as defined by Virginia Women's Center.

Qualifications To perform this job successfully an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education, Experience and/or Licensure Minimum education of high school diploma or general education degree (GED)
Minimum of one (1) year of medical billing experience required; three (3) years of medical billing experience with a comprehensive knowledge of insurance is preferred. Related experience and/or training; or equivalent combination of education and experience will be considered.

Knowledge, Skills & Abilities Knowledge of accounts receivable practices and medical business office procedures.

Knowledge of office coding, billing, and operating policies and procedures.

Knowledge of insurance carrier reimbursement procedures and practices.

Knowledge of practice management software.

Ability to examine documents for accuracy and completeness.

Ability to prepare records in accordance with detailed instructions.

Ability to communicate effectively and clearly.

Ability to work effectively with co-workers as a team member.

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, procedure manuals, and memos.

Ability to make mathematical calculations, balance and reconcile figures, and make changes accurately.

Ability to maintain strictest patient confidentiality.

Ability to communicate with patients, insurance companies, & physicians to ascertain insurance information in a pleasant and helpful manner (includes hostile patients).Ability to maintain a high level of accuracy in computer data entry and posting of payments.

Skill in grammar and spelling.

Skill in maintaining departmental quality assurance and quality control standards.

Physical Demands Requires sitting and standing associated with a normal office environment. Manual dexterity using a calculator and computer keyboard.

Work Environment Work is performed in a busy office environment. Frequent contact with insurance carriers and patients. May involve dealing with angry or upset individuals.

Benefits & RewardsA service-centered culture reflecting a strong work-ethic and caring, compassionate team members

Competitive compensation and growth opportunities

Health, dental, and vision insurance

Health savings accounts (HSA) and flex spending accounts (FSA)401k plan with employer contributions and match

Paid time off and paid holidays

Life insurance both employer-paid and voluntary

Critical illness and accident insurance

Annual employer contribution toward uniforms/scrubs

Employer paid long-term disability benefits and comprehensive employee assistance programA variety of discount programs offered to employees

Employee referral bonus and peer recognition programs

Company-sponsored FUN events and community volunteer opportunities

Virginia Women's Center is a full-service women's health care practice specializing in gynecology, obstetrics, urogynecology, weight and wellness, high-risk obstetrics, obstetrical genetic counseling, breast health/mammography, bone and mental health services, ultrasound, and surgeries and…