Accounts Receivable Billing Specialist

JOB SUMMARY:

Under the direct supervision of the Director of A/R, the Medical Billing Specialist is responsible for processing timely, complete and accurate billing information in compliance with government and third party payers to insure prompt and accurate reimbursement.

JOB SUMMARY:

Under the direct supervision of the Director of A/R, the Medical Billing Specialist is responsible for processing timely, complete and accurate billing information in compliance with government and third party payers to insure prompt and accurate reimbursement. ESSENTIAL DUTIES:

• Prepare, review and process healthcare claims to the clearinghouse for the Managed Care Organizations (MCOs), Medicaid, Medicare and commercial insurance companies using billing software.
• Entering claims using CPT, ICD-10 codes and other medical terminology.
• Meet coding deadlines to expedite the billing process.
• Review all insurance payments for accuracy and compliance with the contract discount.
• Following up on unpaid claims within the standard billing cycle.
• Identify, research, resolve and/or appeal denials, exceptions and exclusions.
• Manage patient and insurance inquires.
• Maintain records of medical billing.
• Validate eligibility, benefits, deductibles and produces accurate documentation.
• Assist in the development and implementation of operational improvements.
• Continuously learn about healthcare coverage options and benefit plans.
• Communicate with management of payer trends identified.
• Enter payment posting and adjustments.
• Contribute to the development and maintenance of the Agency’s systems through the timely completion of assigned documentation and in accordance with applicable legal, fiscal, licensing and accreditation regulations and standards.
• Maintain current knowledge and skills through reading and utilizing coding resources. Attends and participates in coding education systems.
• Respect the privacy of clients. All client material should be handled in accordance with Agency guidelines on confidential material.
• Ad-hoc analysis and reporting as necessary.
• Other duties as assigned by management.

• Attend scheduled staff meetings, supervision, and on-going training.
• All required trainings, certifications and licensure must be kept current in accordance with applicable licensing and accreditation regulations and standards.
• Maintain high standards of ethical and professional conduct and adhere to Agency policies and procedures.
• Other duties as assigned by management.

• Education:
  
  Associates Degree preferred.
• Licensure/Certification:
  Medical coding certification preferred
• Competency/
  
  Skills:
• Core Expertise:
  Possess skill, knowledge and abilities to perform the essential duties of their role; keeps knowledge up to date.
• Independent Judgment:
  Demonstrate ability to perform job responsibilities with a high degree of initiative and independent judgment.
• Cultural
  
  Competency:
  
  Demonstrate awareness, sensitivity and skills in working professionally with diverse individuals, groups and communities who represent various cultural and personal background and characteristics.
• Interpersonal Communication:
  Communicate clearly using verbal, nonverbal, and written skills in a professional context; demonstrates clear understanding and use of professional language.
• Professional & Ethical Conduct:
  Adhere to professional values such as honesty, personal responsibility, and accountability;
  Applies ethical concepts within scope of work and adheres to Agency policies and procedures.
• Collaboration and Teamwork:
  Function effectively as a member of a professional team that includes employees, clients and family members.
• Problem Solving & Decision Making:
  Recognize problems and responds appropriately; gathers information and sorts through it to identify and…