Billing Ops Specialist

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POSITION SUMMARY
This position will process administrative and/or correspondence driven billing requests including insurance updates, demographic changes, eligibility reviews, adjustment reviews, diagnosis updates, patient appeal requests, and other patient and/or client requests as required. Responsible for coordinating and facilitating government and third party insurance claims submission, account refunds, complex adjustments and collection inquiries; required to interact with all levels of personnel.

CORE FUNCTIONS
1. Processes, responds to, or posts correspondence, administrative requests, adjustments, transactions, and/or billing related requests as required and in a timely manner in accordance with departmental policies, procedures and performance goals.

2. Ensures that internal audits and quality controls are in place in accordance with departmental policies, procedures, generally accepted accounting practices and all applicable laws and regulations. Interpret and resolve written and phone correspondence involving bill transfers, adjustments, credit balances and refunds to facilitate prompt and accurate payment.

3. Supports billing operations by providing strategic operational support in the functional areas of billing as required including customer service, third party, submissions, order entry, cash applications, patient refunds, error processing, LTC, client billing, etc.

4. Collaborates with internal areas of billing and external payers to help actively research and resolve billing issues.

5. Proactively communicates escalated billing issues or trends to the billing management team.

KNOWLEDGE/SKILLS/ABILITIES

• Ability to clearly and efficiently communicate complex issues using strong verbal and written aptitude.

• Extensive knowledge of billing, insurance, computer systems, and medical billing processes.

• Ability to prioritize and complete multiple tasks.

• Excellent communication skills, both written and verbal.

• Excellent organizational skills. Intermediate computer knowledge with various programs/software.

• Ability to work independently and accurately with high volumes of data and minimal supervision.

• Ability to effectively interface with patients and/or clients.

MINIMUM QUALIFICATIONS

• High School diploma.

• Two (2) years of related experience in medical billing or in a healthcare setting.

PREFERRED QUALIFICATIONS

• Extensive knowledge of clinical laboratory operations.

• Three or more years’ of related medical billing/insurance experience.

• Comprehensive knowledge of ICD-10 coding, CPT coding, HCPCS coding, modifiers, and government and commercial payer guidelines, advanced working knowledge of Xifin.

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