Medical Billing Specialist

STATEMENT OF PURPOSE:

The billing specialist is responsible for the accurate submission and reimbursement of claims; utilizing established company and departmental production and quality standards, as well as policies and procedures.

JOB DUTIES/RESPONSIBILITIES:

1. Assist the billing manager with insurance/billing clerical duties.
2. Report to the billing manager any and all claims, tickets, charges, payments or other information or communication that is unclear, or not in line with the billing rules of FFA.
3. Use data provided by the doctors on the fee ticket and in electronic health record to generate and submit claims to insurance companies. Claims cannot be changed from fee ticket without billing manager authorization.
4. Review and verification of patient account information against insurance program specifications. Updating patient information as necessary.
5. Obtain missing information directly from the patient or indirectly from other FFA staff necessary for filing a claim (i.e. referrals, updated insurance information, authorizations, etc)
6. Resolve routine patient billing inquiries and problems, follow up on balances due from insurance companies and verification that payments received are accurate to contracted amounts.
7. Submission of claims following appropriate billing policy procedures, and procedures for billing activities including follow-up on third party approvals and collection of overdue patient accounts.
8. Process claims, denials, appeals and adjustments as needed for compliance with established policies, regulations, procedures and standards.
9. Support and communicate with billing manager to resolve issues with delinquent accounts, collections, special adjustments, and/or write offs.
10. Maintain current and up-to-date reporting of tasks and activities in staff checklists. Log all claims worked in Staff Log.
11. Prepare and/or maintain requested reports on billing and collection activities as needed for billing manager and physician review.
12. Represent FFA at business meetings with billing partners, client, hospital, and other related organizations.
13. Assure compliance with applicable industry rules and regulations.
14. Participate in mandatory company training to stay up to date on healthcare billing laws, rules, regulations, and developments necessary to perform duties
15. Prioritizes patient communications according to medical need and urgency.
16. Communicates clearly and establishes/maintains an effective working relationship with patients, fellow FFA staff and the public.
17. Perform other job-related duties as may be assigned or required.
18. Read, understand, and adhere to FFA’s Compliance Program.

JOB REQUIREMENTS:

• High School Diploma or GED
• 1-2 years of experience preferred
• Knowledge of medical billing and insurance claim filing
• Knowledge of ICD-10 & CPT-4 coding including modifiers
• Ability to make and evaluative judgments; strong organizational, problem solving and analytical skills