Billing Specialist

Position Summary

POSITION SUMMARY:

The Billing Specialist ensures that insurance companies and healthcare facilities keep accurate records. Performs clerical functions for patient billing, including verification of insurance information and resolution of problems to ensure a clean billing process. Follows up on accounts that require further evaluation. They work closely with customers, patients, or company personnel to create invoices and check calculations on billing statements so there are no errors in payment procedures.

• Compile, record, store, and analyze organization’s financial information.
• Receiving and sorting incoming payments with attention to credibility.
• Verify patient information, insurance coverage, and eligibility, and investigate claim denials or discrepancies.
• Manage the status of accounts and balances and identify inconsistencies
• Review explanation of benefits from insurance companies
• Investigate claim denials and communicates with insurance companies and patients with any issues.
• Check figures, postings, and documents for correct entry, mathematical accuracy, proper codes, and compliance with company policies.
• Prepare and submit claim appeals with supporting documentation when claims are denied and track and monitor appeal progress.
• Investigate and resolve complex claim issues, including those involving medical necessity, coding or billing errors.
• Provide excellent customer service to patients, addressing inquiries and resolving issues related to insurance claims and balances.
• Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
• Other duties as assigned.

A.

KNOWLEDGE, SKILLS AND ABILITIES:

• Must have thorough knowledge of all insurance procedures to include, but not limited to, registration requirements, collection of co-pays, co-insurances, deductibles, and allowable procedures and charges HPPA laws and regulations.
• Must have knowledge of maintaining health care records.
• Must be computer literate experience preferred.
• Must be able to deal with all patients or visitors regardless of their temperament with proper decorum.
• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Must have excellent organizational skills.
• Must know medical terminology.
• Must have excellent verbal and written communication skills.
• Must possess excellent customer service skills.
• Ability to read, comprehend simple instructions, write simple correspondence, and memos.
• Ability to calculate figures and amounts such as discounts, interest, commissions, and percentages.
• Ability to multitask and prioritize work in a fast-paced environment while effectively meeting goals.
• Attention to detail and accuracy required.

EDUCATION, EXPERIENCE AND

SKILLS REQUIRED:

• High School Diploma or equivalent
• Minimum of 3-5 years’ experience in administrative medical office setting