Billing Specialist

Summary:

The Billing Specialist is responsible for calculating and collecting payments for services.

Education and Work Experience:

Education generally equivalent to a high school diploma is preferred. One to three years of verifiable work history, including experience in medical billing preferred.

Nature & Scope – Principal Areas of Responsibilities:

(This list of duties and responsibilities is not all-inclusive and may be expanded to include other duties and responsibilities, as management may deem necessary from time to time)

-Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.

-Monitor outstanding claims for processing.

-Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates).

-Ensure that patients and insurance providers are billed quickly and accurately.

-Update patient data, develop payment plans, and prepare invoices.

-Call insurance companies regarding any discrepancy in payments if necessary.

-Identify and bill secondary or tertiary insurances.

-Review, research, investigate, negotiate, process, and adjust all claims, including denied claims as necessary.

-Assist and support the billing department with administrative and logistical tasks to ensure the accomplishment of billing-related projects. For example: automatization of the weekly billing process, receivables and payables, etc.

-Apply knowledge of applicable laws, regulations, and compliance requirements to ensure that claims are processed properly (e.g., HIPAA, PPACA/Health Care Reform, state-specific regulations/grievance procedures).

Knowledge / Special Skills / Abilities Needed:

-Knowledge of ICD-10 and CPT coding.

-Strong computer skills with proficiency in software applications, such as Word, Excel, and Electronic Medical Records.

-Effective oral and written communication and presentation skills, as well as interpersonal skills.

-Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.

-Ability to work effectively in a team environment.

-Ability to gather and analyze statistical data and generate reports.

-Ability to plan, coordinate, and administer complex administrative systems and processes.

-Ability to work with frequent, established deadlines.

-Ability to develop, plan, and implement short- and long-range goals.

Contact Information: www.caretrulyhealthcare.com “Our Family TRULY CARING for Yours” “Nuestra Familia Realmente Cuidando de la Suya”

Confidentiality Notice:

This document and all attachments may contain confidential information. Use and further disclosure of the information must be consistent with applicable laws, regulations, and agreements. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this message is strictly prohibited. Immediately destroy this message and notify the sender. Opinions, conclusions, and other information in this message that do not relate to the official business of this organization shall be understood as neither given nor endorsed by it.

Direct: (414) 269-4550 Fax: (414) 763-6110 Address: 3236 W. Loomis Rd. Greenfield, WI 53221 Job Description – Scheduling – 08/2021

Essential Functions / Physical Demands:

80% sitting; 20% walking/standing; on occasion the incumbent may be required to stoop, bend, or reach above the shoulders. The incumbent must occasionally lift and/or move up to 25 pounds. Specific vision required by this position includes close vision, distance vision, and the ability to adjust focus.

Work Environment:

This position is primarily an office-based position. The incumbent occasionally performs work-related travel. May be subject to work as a Personal Care Worker and be exposed to those physical and work environments.

Note:

Physical demands and work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job description is intended for the purpose of position evaluation and salary positioning and is not a contract setting forth the full scope of employment. The agency retains the right to deviate from the description at its discretion, without notice.

The above statements reflect the general details necessary to describe the principal functions of the occupation described and shall not be construed as a detailed description of all work requirements that may be inherent in the occupation