Remote Medical Billing Specialist

Overview

Remote Medical Billing Specialist role focused on back-end accounts receivable follow-up, resolution of aged accounts, and denial management for Hospital and/or Physician Billing. The team supports remediation of third-party accounts receivable and various revenue cycle outsource capabilities. The primary responsibility is to resolve assigned accounts by following up with commercial and government payers on denied, underpaid, or otherwise unresolved claims and collecting insurance claim balances for the client.

This position requires in-depth research and problem solving to achieve resolution while maintaining productivity and quality outputs.

• Perform second-tier account follow-up activities in accordance with organizational, client and regulatory guidelines for outstanding insurance receivables, including high-dollar accounts receivable.
• Research items requiring further assistance and apply knowledge of the healthcare revenue cycle to help achieve quality control standards.
• Communicate professionally with colleagues, payers, and clients as needed.
• Ensure accurate and complete account follow-up by understanding carrier-specific reimbursement applicable to claim processing, including eligibility discrepancies, UB-04 and/or 1500 claim form review, DRG, per diem, case rate, and fee schedule reimbursements.
• Identify and communicate AR trends, payer behavior, workflow inconsistencies, or other barriers to account resolution to the team and engagement leadership.
• Research and document any correspondence received related to assigned accounts.
• Assess accounts for balance accuracy, confirm correct payer billed, coding accuracy, denials, and outstanding insurance requests.
• Provide documentation and submit corrections; escalate to re-processing in a professional and timely manner if payer error is identified.
• Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.
• Contact third-party payers and government agencies to resolve outstanding account balances.
• Maintain departmental productivity and quality standards.
• Possess general PC aptitude and keyboarding ability; typist speed of at least 40 words per minute.

• Minimum of 1-2 years in Healthcare Provider Revenue Cycle experience.
• High School Diploma or equivalent required;
  Associate's or Bachelor's Degree preferred.
• Hands-on experience using Epic, Cerner, Invision, Soarian, McKesson, Allscripts, Meditech, and other industry-recognized Revenue Cycle Management Systems.
• Hands-on knowledge of UB-04 and/or HCFA 1500 billing and account follow-up, CPT and ICD-10 coding and terminology for hospital and/or ambulatory/physician billing.
• Ability to sit for long periods; manual dexterity as needed; physical requirements may include occasional exertion such as lifting up to 15 pounds and frequent computer use.

• PTO, paid sick leave, paid holidays
• Opportunity for career growth