|Employer:||Access Solutions Medical Group
|Specialties:||primary care, family medicine
|Required Experience:||1 to 2 years
|Location:||4716 West Urbana, Suite 211 Broken Arrow 74012, AA, US
The most important responsibility of the medical billing specialist is to get the provider paid promptly and to insure billing practices are ethical and compliant with government regulations and guidelines when doing so.
- Collect and entering medical claim information.
- Post insurance and patients and manage accounts.
- Submit claims and following up with insurance carriers on unpaid or rejected claims.
- Answer patient inquires on account status and charges.
Knowledge, Skills, & Abilities
- Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper.
- Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered.
- Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
- Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
- Prepares patient statements for charges not covered by insurance. Mails statements on a regular basis.
- Works with patients to establish payment plan for past due accounts in accordance with provider policies.
- Provides necessary information to collection agencies for delinquent or past due accounts.
- Posts insurance and patient payments.
- Performs collections for patient past due accounts to include contacting and notifying patients via phone or mail.
- Prepares and submits secondary claims upon processing by primary insurer.
- Follows HIPAA guidelines in handling patient information.
- Periodically create insurance or patient aging reports.
- Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
- Verify patient benefits eligibility and coverage.
- Knowledge of and ability to properly apply ICD 10 diagnosis and CPT treatment codes.
- Knowledgeable on insurance and reimbursement process.
- Good math and data entry (typing) skills.
- Exercises good judgement and discretion.
- Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information.
- Proficient in use of computers and common office equipment.
- Good verbal and written communication skills.
- Understanding of medical ICD 10 codes and CPT medical billing codes.
- Good telephone and patient relation skills.
- Detail oriented and ability to prioritize work.
- More experienced insurance billing specialists work with minimal direction and oversight.