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Medical Billing Specialist Job in Commerce, Georgia

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Job Title: Medical Billing Specialist

Employer:ELINA Healthcare
Type:OTHER
Skills:coding,billing,credentialing
Specialties:family practice, urgent care, laboratory
Location:,Commerce 30529, GA, US
Date Posted:2/4/2021

I.                   JOB TITLE

·         Billing Specialist

 

II.                REPORTING STRUCTURE / SUPERVISORY RELATIONSHIP

·         Reports to Billing Director on all matters relating to insurance and billing requirements.

·         Reports to Practice Manager on all other practice administration and personnel issues, insurance and billing.

·         Reports to Clinical Services Director for any clinical issues.

 

III.             DUTIES, RESPONSIBILITIES AND PROCEDURES

·         Through direct efforts and coordination of others efforts, ensure timely and accurate processing of claims and reimbursements in a manner that is consistent with industry best practices.

·         Daily reconciliation of billing and reimbursements. 

·         Coordination of timely collection of amounts past due to achieve practice aging goals.

·         Provide service of the highest quality in a professional and courteous manner to our referral sources and patients.

·         Ensure compliance with industry standards, regulations, and company policy and procedure.

·         Verify and update accounts with new patient demographic information received daily.

·         Responsible for making sure all appeals have the appropriate documentation before mailed.

·         Assists department with research of claims not paid and other duties assigned.

·         Posts payments

·         Filing

·         Initiate & respond to telephone inquiries from clients, patients & others

·         Documents all communications and activities in billing and financial notes in AdvancedMD to assist with clear, concise and accurate communication to all who work with patients billing ledgers and processes.

·         Adhere to billing requirements of Medicare, Medicaid, and managed care plans, commercial carriers, worker’s compensation, DOL and non-sub programs.

·         Uses acquired knowledge and experience to achieve objective of furnishing prompt, accurate information to the correct party to expedite payment of maximum allowable benefits.

·         Acts as public relations agent for the medical office when dealing with patients, employers and insurance companies.

 

·         Posting Checks:

-          Posts monies and checks received from insurance claims and patient payments for - daily.

-          Check EOB’s and reimbursement is correct with negotiated rates and fee schedules.

-          Once posted, ensure account has ‘$0’ balance, if not ‘work the account’ and resolve outstanding balance.

-          Attend to any refunds immediately by referring them to the financial officer.

-          Make appropriate notes in billing ledger of any action taken or in process.

-          Resubmit and appeal claims as required

-          Manages the resolution of claims with individual carriers or agencies.  Insures maximum reimbursement.

-           

·         Insurance:

-          Assists in administrative work managing the insurance and other reimbursement functions of the practice.

-          Monitors changes in regulations and medical insurance industry and assists in adjusting operating procedures accordingly. Aggressively pursues reimbursement through settlement negotiations.

-          Monitors monthly insurance reimbursement compliance.

-          Maintain comprehensive up to date listing of insurance carrier contracts and claims processing persons.

-          Review regularly all bulletins and correspondence from carriers for up to date changes and keep for easy reference.

-          Keep all insurance reference materials, manuals and forms organized.

-          Assists in adhering to compliance regulations of CMS.

-          Handles phone inquiries from patients and insurance companies.

-          Adhere to billing requirements of Medicare Part B (NCCI), managed care plans.

·         Other duties:

-          Chronological Filing of all EOB’s

-          Answer correspondence and/or telephone inquiries from insurance companies.

-          Process and follow-up on insurance company correspondence including requests for information, and claim review.

-          Work with patients who have insurance claim difficulties.

-          Assists with answers telephone calls during the day

-          Covers front desk in absence of front desk representative

-          Assist with pulling and filing of patient charts

-          Works with Billing Director to provide information necessary to generate financial statements and to accomplish fiscal audits and reimbursement studies.

-          Research problem areas related to reimbursement and payer requirements.  This is done upon request or as problems are identified, by reviewing EOBs with daily and random audits.

·         Solves difficult insurance claim problems.

·         Responsible for keeping work area clean, neat and in a manner that is safe as required by OSHA, as well as free of food and any moisture.

·         Ensures all computer programs are closed down when leaving work area and at the end of every day.

·         Is familiar with complies with and incorporates office policies and procedures in daily duties.

·         Maintains knowledge and complies with all personnel and other established job-related policies and procedures. Understands and includes the practice’s mission statement in daily performance of job duties.

·         Is familiar with and adheres to personnel code of conduct.

·         Understands and adheres to practice policy on patient and office confidentiality.

·         Complies with all rules, regulations and procedures of the Practice Compliance Program which includes but is not limited to OIG Program, HIPAA, OSHA, CLIA and any other state, local or federally mandated regulations that affect a physician’s office.

·         Informs practice manager and compliance officer of any concerns related to any compliance issues (OIG, HIPAA Privacy and Security, TSBME etc).

·         Assists billing associate and financial officer as needed daily to ensure daily department goals and job duties are met.

·         Performs any other duties as requested and delegated by physician, chief financial officer or practice manager.

 

IV.             QUALIFICATIONS & EXPERIENCE

·         Graduate of Medical Billing and Coding program.

·         Two years medical office billing experience, preferred.

·         Previous medical insurance processing experience, preferred.

·         Two years’ experience working with Medicare, Medicaid and managed care insurance procedures, preferred.

·         Current courses and knowledge of ICD-10 and CPT-4 coding.

·         Knowledge of medical terminology.

·         Thorough knowledge of billing policies and procedures.

·         Proficiency in filing and collecting insurance claims.

·         Analytical skills to examine billing information for accuracy and completeness.

·         Ability to collect accounts in arrears in a sensitive manner.

·         Previous experience with electronic claim filing and practice management software packages.

·         Computer literate in current Windows applications – word, excel, access, outlook.

·         Typing skills.

·         Ability to coordinate sequence of operation of a system and can revise procedures based on the analysis of data.

·         Knowledge of healthcare administration and specifically healthcare billing and reimbursement procedures and regulations. 

·         Knowledge of medical professional fee billing

·         Basic accounting skills

·         Skill to accurately audit patient ledgers

·         Skill to organize & prioritize workload, keep a personal procedure manual, coordinate many assignments simultaneously & meet deadlines

·         Skill to perform computer & data entry functions

·         Calculator by touch

 

                  Continuing Education

·         Attends in-service education programs that are job related.

·         Shows an interest in and provides proof of, upgrading skills and attends (at own cost) continuing education that is job related, on an annual basis.

·         Cross training with Billing Director.

·         Attends all in-service training on Practice Management Software.

·         Maintains any certifications with required annual CEU.

 

V.        PERSONAL QUALITIES AND CHARACTERISTICS

·         Ability to communicate well with people both in personal contacts and on the phone.

·         Professional, friendly appearance, good personal and dental hygiene.

·         Good organizational skills.

·         High accuracy and precision.

·         Methodical.

·         Pays attention to detail.

·         Ability to recognize, evaluate, solve problems and correct errors.

·         Skills in establishing and maintaining effective working relationships with other employees, patients, insurance carriers and the public.

·         Ability to maintain patient and office confidentiality.

·         Verbal & written communication skills

·         Skill to effectively negotiate with patients, guarantors & other parties for payment of claims

·         Effective interpersonal skills

·         Ability to work independently with only general supervision

·         Problem solving skills

 

 

VI.       WORK CONDITIONS

 

ACTIVITY

Occasionally

Frequently

Continuously

     Hrs 

a.  Sitting

 

 

X

 

b.  Walking

X

 

 

 

c.  Standing

X

 

 

 

d.  Bending

X

 

 

 

e.  Squatting

X

 

 

 

f.  Climbing

X

 

 

 

g.  Kneeling

X

 

 

 

h.  Twisting

                X

 

 

 

 

  • Requires manual dexterity sufficient to operate office equipment, including but not limited to keyboard, copier, telephone, fax machine and calculator. 
  • Requires a normal range of hearing and vision, and the ability to communicate clearly with office personnel and community.
  • Work is normally performed in a typical interior/office work environment. May require some travel to include driving or flying.
  • No or very limited physical effort required.
  • Work environment involves minimal exposure to physical risks, such as operating dangerous equipment or working with chemicals.
  • Work involves moderate exposure to unusual elements, such as extreme temperatures, dirt, unpleasant odors, and/or loud noises.
  • Light physical effort. Requires handling of average-weight objects up to 20 pounds or some standing or walking. Effort applies to no more than two (2) hours per day.
  • Requires ability to lift up to 50lbs, push and pull 50lbs.
  • Some bending, stretching, lifting and stooping may be required. 

 

VII.          WORK SCHEDULE

·         Monday - Friday: 7:00 am – 4:00pm (or as directed by Billing Director)

·         Other office hours as dictated by patient and practice needs.

·         May be required to work some overtime dependent on patient load and practice needs.

 

 

VIII.       PERFORMANCE STANDARDS:

 

 

 

Performance Standards                                             Performance Tracking                                                         

v  100% accurate verification of insurance coverage

 

v  Able to process 40 – 50 patients in the office per day

 

v  100% co-pay, deductible and OSB collection

 

v  100% accuracy in scheduling appointments.

 

v  100% accuracy in messages emailed to physicians and other employees.

 

v  100% accuracy for daily posting and reconciliation

 

v  timely and accurate posting of claims

 

v  timely and accurate refiling of claim denials and appeals

 

v  100% accuracy of verification of correct write off of adjustments/contractual disallowed

v  EOB denials

 

 

 

v  Office visit volume and accuracy of edit reports.

v  Co-pays, deductible and OSB payment posting

 

v  Patient appointments, patient and physician feedback.

 

v  Physician/staff feedback.

 

 

 

v  Daily reconciliation of posting of payments

 

v  Within 24 hours of receipt of payment and EOB (EOB audit)

 

v  Within 24 hours of receipt of denial (EOB audit)

 

v  Verification against provided fee schedules of all contracts (audit of write offs against contracted rates)

Applying

Please email resume to Heather Lackey hnlackey@gmail.com

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