Billing Specialist

Role Overview

• Verify patients’ insurance and benefits.
• Communicate patients’ responsibilities.
• Notify management of identified trends as needed, and at month-end, arrange payment plans.
• Enroll patients in Financial Assistance Programs.
• Submit prior authorization requests to payor websites, fax, or phone.
• Obtain medical records or LMNs that the insurance company requests for prior authorization and billing.
• Submit electronic and paper claims to insurance carriers.
• If the patient declines, complete a cancellation form or offer payment options.
• Communicate with clients.
• Offer prompt pay discounts, arrange payment plans, and provide financial assistance as needed.
• Meet daily and monthly departmental productivity goals set by management to achieve the company's financial goals.
• Ensure completion and recording of documentation.
• Be responsible for protecting, securing, and properly handling all PHI (Protected Health Information).
• Research, review, and communicate with insurance carriers regarding open accounts receivable.
• Prepare and submit appeals.
• Timely management of unpaid claims.
• Coordinate the release of medical information to insurance companies, lawyers, state, and federal agencies.
• Meet all audit requests within the allotted time frame.
• Correct claim errors and coordinate, monitor, and manage the follow-up on unpaid claims in a timely manner.
• Collaborate with healthcare providers to resolve pre-certification issues and ensure the timely delivery of medical services.
• Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer.
• Communicate with insurance companies and healthcare providers and review medical records and documentation to ensure compliance with pre-certification requirements.
• Ensure that all payers needing prior authorization are set up correctly within the software system.
• Communicate with private practice, facility, and nursing home clients regarding medical record needs.
• Handle difficult situations involving patients, physicians, or others in a professional manner.
• Perform other duties as assigned and have flexibility to be cross trained to meet departmental needs.
• Maintain accurate and up-to-date records of pre-certification approvals and denials with confidence.
• Attend meetings for updates, communications, and learning opportunities.
• Maintain a good working relationship within the department, with clients, insurance carriers, and other departments.
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
• Performs pre-service authorization reviews to obtain payment authorization for outpatient services.
• Succinctly abstracts fact-based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates the clinical information in a timely manner supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.

Requirements

• Excellent customer service skills, with a focus on professionalism
• Ability to solve problems, prioritize tasks, and multitask effectively
• Goal-oriented mindset with excellent time management and organizational skills
• Strong interpersonal communication skills, including the ability to interact efficiently with individuals at all levels in an organization
• Strong level of empathy & patience
• Excellent verbal and written communication skills
• Attention to detail, accuracy, and time management
• Proficiency in PC-based software such as Microsoft Excel, Teams, iPhone, Adobe, and associated applications
• A fundamental understanding of medical billing concepts
• Knowledge of Medicare, Medicaid, and commercial insurance
• Familiarity with HIPAA (Health Insurance Portability and Accountability) privacy requirements
• Knowledge of Availity and eligibility portals and medical terminology
• Follow up on missing or incorrect information so patients receive the right reimbursement.
• Document account activity using correct medical and billing codes.
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Be investigative to find necessary information, if needed
• Ability to handle multiple priorities and meet deadlines
• Ability to work independently and as part of a team in a fast-paced environment
• Demonstration of self-motivation and ownership of assigned work
• A high level of professionalism and confidentiality in handling sensitive information is imperative.
• Excellent verbal & written communication skills.

Benefits

• Excellent full time benefits including comprehensive medical coverage
• Dental and vision options
• Life and disability insurance
• 401(k) with company match
• Paid vacation and holidays