Medical Billing Specialist

Position Summary:

We are actively seeking an experienced and motivated Medical Billing Specialist to join our team. The successful candidate will play a crucial role in managing the billing process from claim submission to collection. The tasks include verification of benefits, clean claim submission, denial management, claim appeals, and resolving billing-related issues with insurance companies, patients, or other responsible parties for services rendered, as well as maintenance of contracts and provider credentialing status. The ideal candidate should possess in-depth knowledge of billing and collection practices and have a strong track record in resolving complex financial situations.

Job Details:

Work from home

Monday to Friday | 4 PM to 1 AM (Manila Time)

*Following US Holidays

Responsibilities:

• Verification of Benefits
  • Verify insurance benefits including coverage, co-pays, and deductibles via AthenaOne auto-verification, or via the internet or phone manually if required, for all new patients and again prior to all follow-up visits.
  • Clearly communicate insurance coverage status (co-pays, deductibles, etc.) to the front desk team so that patients and families understand and agree to their coverage for our services.
• Claims Processing
  • Prepare and submit clean claims to insurance payers using AthenaOne automated platform.
  • Review insurance remittance advice and rebill as applicable
  • Evaluate payments/denials received for correctness and ensure they are applied accordingly.
  • Detect any overpayments and/or duplicate payments and investigate and resolve accordingly.
  • Process refund requests, in accordance with policies and procedures.
  • Resolve issues that caused a denial within 5 days of receipt of denial.
• Revenue Cycle and Patient Account Management
  • Regularly review outstanding patient accounts for resolution, recommend and submit write-offs, process refunds and adjustments as applicable, provide status updates on delinquent accounts, issue collection letters, and make collection calls as necessary, in accordance with established policies and procedures.
  • Ensure accurate addresses are maintained in the billing software to send monthly statements.
  • Perform all applicable month-end close duties to ensure the accuracy of data and claims.
  • Consistently look for areas to maximize claim reimbursement.
• Internal Assistance with Credentialing
  • Help to review and maintain payer contracts
  • Work with credentialing specialists to update and add new providers to payer contracts as required
  • Review and maintain provider information up to date in registries (CAQH, NPPES, PECOS, state licenses, DEA, etc.)
• Quality Care
  • Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
  • Maintain a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
  • Ensure that the collection operations are conducted in a manner that is consistent with overall department protocol and follows Federal, State, and payer regulation, guidelines, and requirements.
  • Recognize and support patients' rights and responsibilities in the performance of job duties, while respecting their privacy and confidentiality.
  • Ad-hoc Tasks: be prepared to undertake other related tasks as they arise, demonstrating flexibility and a team-oriented mindset

Qualifications:

• A high school diploma or general education degree (GED) equivalent.
• Demonstrated excellence (at least 3 years experience) in medical billing.
• Some credentialing experience is a plus.
• Experience with AthenaOne EMR/billing software is preferred.
• Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
• Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
• Strong work ethic with personal qualities of integrity and credibility.
• Self-directed, detail-oriented, conscientious, organized, and able to follow through.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.