Medical Billing Specialist
3 weeks ago
The Medical Billing Specialist is responsible for ensuring the accurate submission of medical claims to insurance companies, managing accounts receivable, and ensuring timely collections. The role requires a deep understanding of medical billing and coding processes, insurance policies, and the ability to communicate effectively with patients and insurers. This position will also assist with patient inquiries, posting payments, and supporting overall revenue cycle operations.
Key Responsibilities- Claim Submission & Processing : Prepare and submit medical claims to insurance companies, ensuring accuracy and adherence to coding guidelines (CPT, ICD-10, HCPCS).
- Billing & Coding : Verify patient billing and coding for procedures, diagnoses, and treatments to ensure correct reimbursement.
- Accounts Receivable Management : Monitor accounts for unpaid balances, follow up on outstanding claims, and resolve denied or rejected claims through appeals process.
- Insurance Verification : Verify patient insurance coverage, benefits, and eligibility prior to services being rendered.
- Payment Posting : Post insurance and patient payments to the appropriate accounts, ensuring accurate allocation of funds.
- Patient Communications : Handle patient inquiries related to their bills, explain charges, and assist in setting up payment plans if necessary.
- Regulatory & Compliance : Ensure billing procedures comply with industry regulations, including HIPAA, and keep up-to-date with changes in medical billing and coding standards.
- Documentation & Reporting : Maintain accurate billing records and reports, ensuring timely filing and proper documentation for audits and compliance.
- Education : High School Diploma or equivalent required; certification in medical billing or coding (e.g., CPC, CCS).
- Experience : 1-3 years of experience in medical billing, preferably in a healthcare setting.
- Knowledge : Strong understanding of medical billing and coding practices, insurance guidelines, and HIPAA.
- Regulations & Compliance : Knowledge of healthcare regulations and compliance requirements.
- Skills : Proficient in medical billing software and electronic health records (EHR) systems; Excellent attention to detail and organizational skills; Strong communication skills for dealing with insurance companies and patients; Ability to handle sensitive patient information with discretion.
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