Medical Billing Specialist
Medical Billing Specialist
Specialty:Accounting & Finance
Our Client in Boston, MA is looking for a Medical Biller with at least 2 years of physician billing experience to join their team!
The Billing Specialist is responsible for billing and claims resolution for patients, private insurance companies, Medicaid and Medicare. He/she must effectively interact with multiple disciplines including management, financial clearance staff, nursing staff, physicians, commercial insurance carriers, government agencies, and have a high-level of expertise in understanding commercial and governmental insurance carrier rules and regulations, and the ability to manage ongoing change and think creatively.
- Corrects procedure and diagnosis coding on claims held by claim scrubber. Confirms diagnosis and procedures with nurses and physicians to ensure information is correct; adds correct modifiers as needed.
- Verifies that procedure charges are consistent with insurance guidelines to minimize claim denial.
- Attaches patient co-payment and any unpaid balance money received that could not be done automatically by practice management system.
- Responsible for monitoring open encounter list to ensure all encounters received are entered.
- Prepares and submits insurance claims.
- Sends all insurance verification denials to financial clearance team.
- Identifies liability and guarantors; reviews and adjusts account balances.
- Facilitates the interpretation of Explanation of Benefits (EOBs) and follows up as needed.
- Posts payments and adjustments not automatically processed by the practice management system; validates payments and adjustments automatically processed by practice management system.
- Works with athenaHealth employees to resolve claim issues identified via worklists.
- Assists in the collection of past due accounts by following up with insurance companies to learn the status of claims after initial athenaHealth follow-up. Also submits appeals on denied claims as required after initial athenaHealth follow-up.
- Maintains current knowledge of all CPT code changes and billing requirements.
- Attends billing meetings and training courses requested by Billing Manager.
- Maintains HIPAA compliance.
- Other duties as required.
Knowledge, Skills and Required Abilities:
- Knowledge of medical procedures, CPT codes, ICD-10 coding.
- Knowledge of insurance company operating procedures and requirements for billing.
- Must have the ability to maintain confidentiality of patient information and office information.
- Must have the ability to recognize, evaluate, and correct errors.
- Must have the ability to work with other billing office employees / vendors to obtain necessary information.
- Must possess exceptional communication (verbal) skills.
- Must have skills and knowledge of computer, hardware and software. Must have the capability of working well independently as well as under direct supervision.
- Knowledge of athenaCollector is a plus.
- Must have experience working with HCFA 1500s and Medicaid form 5.
- Must have experience working with Medicaid, Medicare and Commercial Insurance.
- High school diploma and 2 years of physician office billing experience are required.