Onsite Location(s)

Description

Basic Accountability Statement:

 The Medical Billing Specialist must demonstrate a broad understanding of billing related functions within their functional areas. As a specialist, this position requires demonstration of a positive and supportive attitude towards Compleat Rehab and Jordan Physical Therapy Centers and its overall success. The Medical Billing Specialist is responsible for ensuring payment is secured for all services by timely filing of secondary/tertiary insurance billings, follow-up, denials, reconsiderations and appeals until all claims are fully adjudicated

Duties and Responsibilities:    

• Act as point of contact for eligibility and third-party billing questions and processes.
• Knowledge of 835 and 837
• Responsible for the processing and of Medicare Part A & B, Medicare Advantage, and private insurance claims
• Reviews all claims for completeness, reasonableness of charges, appropriateness of billing codes, and payer information
• Reviews referrals and pre-authorizations as required for payment of outstanding dates of service.
• Ensure claims meet regulatory requirements
• Pursues timely collection of each claim using thorough follow-up efforts appropriate to each payer, also follow up on insurance claim denials, and exceptions or exclusions.
• Reading and interpreting insurance explanation of benefits.
• Filing appeals when appropriate to obtain maximum reimbursement
• Insurance Verification
• Recheck eligibility and benefits verifications for outstanding dates of service.
• Conduct billing utilizing most efficient resources to secure timely payment of open claims or invoices, giving priority to electronic solutions.
• Review and work from developed aging and denial reports for resubmission of claims to the correct insurance carrier
• Review patient bills for accuracy and completeness and obtain any missing information.
• Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies.
• Timely responses to inquiries from insurance companies, patients, and providers.
• Regularly meet with Billing Manager to discuss and resolve reimbursement issues or billing obstacles.
• Regularly attend weekly/monthly staff meetings and continuing educational sessions as requested.
• Contact insurance companies by phone and/or submit letters of appeal in attempt to collect outstanding payment to obtain maximum reimbursement.
• Follow up on unpaid claims within standard billing cycle timeframe.
• Check each insurance payment for accuracy and compliance with contract discount.
• Identify and bill secondary or tertiary insurances as needed by company.
• All accounts are to be reviewed for insurance or patient follow-up.
• Research and appeal denied claims.
• Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
• Perform additional duties as requested by Management team.

 Education:    

Minimum of three years of experience in a medical office setting preferably in a medical billing and coding, or authorization specialist role. Associate degree or above is preferred.

Experience/Competencies:

• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
• Experience with using coding - ICD10 and CPT Codes as well as medical billing forms- UB04 and 1500
• Basic computer experience, familiar with Microsoft Office Suite.
• Excellent written, verbal, and organizational skills. Health care experience preferred.
• Ability to adapt to changing organizational needs.
• Ability to manage relationships with various insurance payers.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
• Ability to meet strict deadlines.
• Responsible use of confidential information.
• Perform to company standards of compliance with policies and procedures.
• Ability to multi-task and work courteously and respectfully with fellow employees, clients, and patients.
• Working Knowledge of North Carolina Medicaid Billing and the NC Tracks System.

Experience: 

• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Use of computer systems, software, 10 key calculator
• Effective communication abilities for phone contacts with insurance payers to resolve issues
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
• Knowledge of accounting and bookkeeping procedures
• Knowledge of medical terminology likely to be encountered in medical claims

Physical Demands:      The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. Lifting, pushing, pulling are also required.

Working Environment:  This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.  Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

The above is intended to describe the general content and requirements for the performance for this position.  It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.   

I have read the Medical Billing Specialist job description and understand the functions and objectives of the position. 

Compleat Rehab & Sports Therapy Center (“CRS”) offers a competitive compensation and benefits package including medical/dental, vision coverage, HSA, STD, LTD, life insurance, EAP, company-matched 401(k), and paid vacation/holidays. 

Salary Range: $50,000-$70,000

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Compleat Rehab & Sports Therapy is an Equal Employment Opportunity employer.