Medical Billing

We are seeking a highly skilled and detail-oriented individual to join our team as an experienced Medical Billing Specialist (Multi-Specialty). The ideal candidate will possess strong analytical skills, excellent attention to detail, and a comprehensive understanding of medical billing processes. As a Medical Billing Specialist, you will play a crucial role in ensuring the accuracy and efficiency of our billing operations while maintaining compliance with regulatory requirements.

Role & responsibilities

1. Credentialing: Verifies and validates the qualifications, training, and credentials of healthcare providers to ensure that providers are eligible to bill and receive reimbursement from insurance payers for the services they render.
2. Demographics Verification: Verify and update patient demographic information in the billing system with 100% accuracy of patient demographic data such as name, address, insurance information, and contact details. Resolve discrepancies or missing information in patient demographics to prevent claim denials or delays.
3. Charge Entry: Enter charges into the billing system based on the services provided to patients. Verify the accuracy of charges entered, including the correct procedure codes, modifiers, and unit counts. Ensuring compliance with coding guidelines and payer requirements during charge entry.
4. Claim Submission: Prepare and submit electronic or paper claims to insurance companies, ensuring compliance with billing regulations and payer requirements.
5. Claims Management: Monitor outstanding claims, aging reports, and accounts receivable to ensure prompt resolution of unpaid or underpaid claims. Follow up with insurance companies and patients to address outstanding balances. Resubmit corrected claims when necessary.
6. Insurance Verification: Verify patient insurance coverage, eligibility, and benefits prior to claim submission. Obtain pre-authorizations or referrals as necessary.
7. Payment Posting: Post insurance and patient payments accurately into the billing system. Reconcile payments with billed amounts and resolve any discrepancies.
8. Denial Management: Review and resolve rejected or denied claims. Identify reasons for denials, correct errors, and resubmit claims for reimbursement.
9. Compliance: Adhere to billing regulations, coding guidelines (e.g., ICD-10, CPT), and payer policies to ensure accurate and compliant billing practices.
10. Documentation: Maintain accurate and detailed records of billing activities, including claim submissions, payments, adjustments, and communications with payers and patients. Generating reports on billing metrics such as claim acceptance rates, denial rates, and average payment times.
11. Continuous Improvement: Identify opportunities for process improvements, efficiency enhancements, and revenue optimization in the billing process. Collaborate with team members and supervisors to implement best practices.
12. Process Analysis: Conduct comprehensive assessments of existing medical billing processes to identify strengths, weaknesses, and opportunities for improvement.
13. Performance Metrics: Define key performance indicators (KPIs) and metrics to measure the effectiveness and efficiency of medical billing processes. Monitor performance regularly and implement corrective actions as needed.
14. Provide coaching and feedback to junior team members to ensure performance levels are met.
15. Conducting Auditing on Daily basis and Sharing the Feedback to Senior Management and the Individual