Job Description

Job Summary 

The Billing Specialist I is responsible for serving as primary contact person for insurance companies or other payers. This position performs all needed research to ensure claims are filed timely, accurate and efficient in accordance with all billing requirements. 

Essential Functions

Makes daily contacts with insurance companies, patients, patients' family members, and others in a professional and confidential manner through the use of phone, email, and letter to keep accounts current and maintain the organizational AR goals. Identifies credit balances, reclassifies revenue, writes up contractual and administrative adjustments; and ensures the proper use of transaction codes. Thoroughly documents actions taken on accounts utilizing practice management tools and best practice workflows. Evidence of actions taken on accounts are sufficiently documented. Produces timely claims resolutions to ensure maximum collections as measured by revenue realization reports in accordance with PPSI policies. Meets all billing deadlines and accurately submits claims in accordance with insurance and company guidelines. Understands EHR (i.e., Athena, Cerner, Ingenious Med, etc.), payer edits and reports; and corrects claim filing edits in a timely manner. Gathers all new billing updates/information and communicates/trains the team (i.e., staff, providers, etc.). Maintains a central electronic storage location via shared drive for all up-to-date information. Works closely with management, clinic staff, and coding staff to ensure proper billing and collection procedures are being performed on patient accounts. Actively participates in weekly/monthly conference calls to discuss holds and identify trends and resolutions in the workflow dashboard. Demonstrates working knowledge of and maintains updates of Federal, State and other payer billing guidelines; utilizes payer web sites for claims follow-up. Demonstrates excellent communication and problem-solving skills when assisting with questions or resolving problems with patients, clinic staff, and insurance companies. Maintains confidentiality with patients' financial, personal, and medical information according to HIPAA guidelines. Follows the proper chain of command and reports issues, problems, and important information to management. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

Associate Degree in healthcare related field preferred or Technical School Technical School for Medical Billing/Coding preferred 2-4 years medical claims processing, physician practice setting preferred

Knowledge, Skills and Abilities

Kronos, Athena, and the ability to learn multiple new systems being used in the organization to perform daily operational activities

Licenses and Certifications

CPB- Certified Medical Biller through AAPC preferred Certified Medical Insurance Specialist (CMIS) through PMI preferred