Medical Billing Specialist

Description

The Medical Billing Specialist will be responsible for accurately coding and billing medical services, submitting insurance claims, and ensuring timely reimbursement for healthcare services rendered. The ideal candidate will have strong knowledge of medical billing processes, coding guidelines, and insurance regulations, as well as excellent communication skills and attention to detail.

Responsibilities:

• Insurance Billing and Claims Submission: Review patient encounter forms, medical records, and other documentation to accurately assign diagnostic and procedure codes based on coding guidelines (ICD-10, CPT, HCPCS). Prepare and submit insurance claims for medical services rendered to patients, including electronic claims submission and paper claims submission as needed. Verify and update patient insurance information, coverage, and eligibility in the practice management system.
• Claims Processing and Follow-Up: Monitor insurance claim status, including claim denials, rejections, and pending claims, and follow up with insurance companies to resolve issues and ensure timely reimbursement. Identify and correct billing errors, discrepancies, and claim rejections, and resubmit claims as necessary to maximize reimbursement.
• Payment Posting and Reconciliation: Post insurance payments, patient payments, and adjustments accurately in the practice management system, ensuring proper allocation and reconciliation of payments. Reconcile insurance payments with billed charges and identify any discrepancies or underpayments for follow-up and resolution.
• Insurance Verification and Authorization: Verify patient insurance coverage and obtain necessary authorizations and pre-certifications for medical services as required by insurance plans. Communicate with insurance companies, third-party payers, and healthcare providers to obtain authorization for medical procedures and treatments.
• Patient Billing and Collections: Generate patient statements and bills for outstanding balances, co-payments, deductibles, and self-pay accounts, and communicate with patients regarding payment options and financial responsibilities. Assist patients with insurance-related inquiries, billing questions, and payment arrangements, providing excellent customer service and support.
• Documentation and Compliance: Maintain accurate and up-to-date records of billing transactions, insurance claims, payment postings, and collections activities in the practice management system. Ensure compliance with healthcare regulations, coding guidelines, and insurance billing requirements in all billing and claims processing activities.

Requirements

• High school diploma or equivalent required; Associate's degree or certification in medical billing and coding preferred.
• Minimum of 2-3 years of experience in medical billing, coding, or healthcare revenue cycle management, preferably in an OBGYN, Neonatology, or medical practice setting.
• Strong knowledge of medical billing processes, coding guidelines (ICD-10, CPT, HCPCS), and insurance regulations.
• Proficiency in using electronic health records (EHR) systems and practice management software for billing and claims processing.
• Excellent communication and interpersonal skills, with the ability to interact effectively with patients, insurance companies, and healthcare providers.
• Strong attention to detail, accuracy, and problem-solving skills in reviewing and processing insurance claims and billing transactions.
• Ability to prioritize tasks, meet deadlines, and work independently in a fast-paced healthcare environment.