Billing Specialist/Temporary

AIM OF THE POSITION 

The purpose for this position is for an individual to prepare, process, maintain, and manage all aspects related to Billing including benefit and eligibility verification, Order Entry, QC, primary billing and proper documentation.

POSITION WITHIN THE ORGANIZATION

1. Customer Care, Sales, Commercial and external vendors 

2. Cooperates with all departments across the organization

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Primary Billing

• QC of order entry in SFDC orders, as well as payor selections

• Data entry and transfer daily to the Billing System

• Generate charges and electronic claims and print paper claims for various payors requiring paper claim submission

• Utilize Sales Force for tasks and logging calls, and follow-up to assigned collectors, prior -authorizations, or Patient Care Specialist.

• Manage interface errors and upfront claim rejections 

• Perform other related duties as required or assigned such as overflow work, including word processing, data entry, and internet research tasks

• Interface with insurance company representatives, doctor's offices and hospitals regarding the obtainment of medical records, patient demographic and insurance information, and ICD-10 codes.

• Verification of eligibility and medical benefits utilizing appropriate site or vendor and enter benefit detail in Sales Force.

• Ensure in verification of coverage criteria depending on payer policy and interact with Customer Care if anything is needed for coverage verification.

• Utilizes strong analytical skills, including data compilation and attention to detail needed to prepare charges, identify criteria for testing and the ability to request missing information that could hinder a successful claims submission

• Uses the chain of command to escalate problems or situations requiring administrative intervention and notifies the Reimbursement Supervisor or Manager when appropriate.

• Reviews pathology reports and extracts data to determine coverage criteria based on payer policy.

• Maintain client relationships as it pertains to Benefit and Eligibility duties and contacting patient when requested.

• Assists in the development of new procedures and systems to enhance productivity.

• Works directly with Reimbursement Supervisor , Manager, and Director to address and resolve any issues that may affect the Reimbursement Department as a whole.

Interacts with the Customer Care team to resolve any tasks and issues that can prevent an order from processing and billing.

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.

KEY CONTACTS

· Internal: This position may interface with all departments within the company.

· External: External Vendors

EDUCATION AND EXPERIENCE REQUIREMENTS

EDUCATION

Education:

• High School diploma or general education degree

• 3+ years related experience preferable

• Medical Billing Certification or work experience equivalency 

Certificates and License Requirements:

CPT and ICD-10 knowledge 

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)

Specific Knowledge Required:

Knowledge: Comprehension of a body of information acquired by experience or study.

Skill: A present, observable competence to perform a learned activity.

Ability: Competence to perform an observable behavior.

• Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)

• Must be able to work in a fast-paced environment

• Must have strong organizational skills and attention to detail

• High degree of accuracy

• Manage Multiple tasks independently

• General accounting and math skills

• Excellent problem resolution

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS

• Excellent customer service skills

• "Outside the Box" thinker

• Other Skills necessary: Analytical thinking ,  thoroughness, good research skills, and strong verbal/written communication

• Ability to read and extract information from a path report

· PRIVACY NOTICE:  To review the California privacy notice, click here:  https://agendia.com/privacy-policy/ 

· Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.

WORKING ENVIRONMENT

Establishes ADA (Americans with Disabilities Act) requirements 

ENVIRONMENT/SAFETY/WORK CONDITIONS

Working conditions (inside or outside the office)

• General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Maintains a clean, neat, and orderly work area.

• Adheres to Department Specific Safety Guidelines.

• Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.

TRAVEL

No travel is required 

OTHER DUTIES

Other duties as required by management