Medical Billing Specialist

We are seeking a dedicated and organized Medical Billing Associate to join our team. This position involves various tasks aimed at supporting the Revenue Cycle process and ensuring the smooth operation of the clinic and surgical center. The ideal candidate will have a thorough knowledge of health insurance coverage, deductible, co-insurance, out of pocket, referrals, and prior authorizations. The candidate will verify benefits and obtain referrals / prior authorizations, generate estimates, read ledgers, collect payments, set up payment plans, identify mistakes and make corrections on claims. The schedule will be Monday through Friday- 7:30 am-4:00 pm.

Key Responsibilities:

• Review and Update Demographics and Insurance: Verify patients personal and insurance information and make any     corrections to reduce errors in claims processing.
• Insurance Verifications: Verify insurance for all surgery center appointments prior to appointments. Assist Front Desk staff with any inquiries or concerns with eligibility verifications and copays for patients being seen in the clinic. 
• Referrals / Prior Authorizations: Check insurance requirements for PCP Referrals and Prior Authorization requirements and obtain. Communicate with physicians and patients to coordinate receipt of Referrals and Authorizations. Communicate with appropriate staff if appointments need to be cancelled or rescheduled due to not obtaining documentation.
• Prepays: Calculate estimates for scheduled procedures, contact patients to provide estimates, establish payment and document in patients’ charts.
• Patient Communication: Answer patient voicemails, research problems, address inquiries, call patients with Prepay estimates for upcoming procedures, and take payments from patients. Communicate insurance requirements to patients to get claims processed correctly, including Coordination of Benefits and Referral requirements.
• Claims: Work to get clean claims out to Payers and process denials once claims are processed. 
• Administrative Duties: Submit Refund Requests on patient accounts, upload correspondence from Payers, reply to inquiries      related to Prior Authorizations and PCP Referrals, setup Payment Plans on patient balances. 

• A high school diploma or equivalent is required.
• Previous experience in a medical office setting, preferably as a billing assistant or patient account representative, is required.
• Compassionate, patient-focused attitude and dedication to providing exceptional care.
• Strong verbal and written communication skills, with the ability to interact with patients in a professional manner.
• Basic knowledge of medical terminology and familiarity with medical insurance and claims. Ability to multitask, work efficiently, and maintain a high level of organization in a fast-paced environment.