This position is a Sr. Medical Billing Specialist that will coordinate, verify, and distribute billable services. Reporting to the Finance Manager directly this individual with join our Billing Team and provide insights and collaboration into the medical billing arena of Pediatrics.
• Print out list of credits (payments) received in Business bank account and highlight insurance payments to verify application to patient accounts.
• Compare bank list with list of electronic payments that Billing Specialist has received. If missing EOB’s obtain from carrier websites.
• Login to Professional Office Services and check for any problems with the daily batch. Correct any errors in Centricity.
• Check for and process any outstanding charges that have been waiting for the providers to finish or any questions/flags Billing Specialist has sent to providers/MA's.
• Clean up any visits that are duplicates or should not have charges. Transfer any copayments that were applied to the incorrect visit.
• Send older charges to Centricity EDI.
• Record all payment batches in Payment Log and double check they are balanced.
• Provide statistical data for analysis and research, as needed.
• Update Collection report and send out to Billing Specialists and Finance Manager.
• Process DNKA/Same Day Cancellation charges.
• Prepare and transport bank deposit to Chase Bank.
• Add provider visits to monthly visit report.
• At mid-month, balance Payment Log to Centricity.
• Process Refunds to the Finance Manager that need checks.
• Update OHP Comparison, Behavioral Health Procedures, and Monthly Visit Report to prepare for month.
• Once all the payments have been entered for the month, balance the Payment Log to Centricity.
• Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients with regard to coding procedures.
• Conduct regular audits and coding reviews to ensure all documentation is accurate and precise.
• When Billing Specialist has finished Month End reports, move them into the appropriate folders on the M drive.
o Update the dashboard on the M drive with the information from the Month End reports.
o Update Quarterly reports
o Email CPA Summaries for the month to each of the BH providers.
o Complete Complaint Tally spreadsheet on M drive.
• Check employee/patient accounts that don't get statements because they are 'insurance only' accounts and write off any balances.
• Perform Backup Payroll and maintain the signature stamp for signing checks as the Authorized Check Stamp Signer (ACSS).
• Yearly updating of fee schedules according to new Medicare RVU report
• Yearly updating of insurance fee schedules according to any contract changes
• Covering positions when Billing Specialist are out of the office
• Other projects needed by Managers or Providers
• Other duties as assigned.
• Expresses ideas and thoughts verbally
• Exhibits good listening and comprehension
• Selects and uses appropriate communication methods
• Writes clearly and informatively
• Establishes and maintains effective relations
• Exhibits tact and consideration
• Offers assistance and support to co-workers
• Works cooperatively in group situations
• Balances team and individual responsibilities
• Contributes to building a positive team spirit
• Supports others’ efforts to succeed
• Exhibits confidence in self and others
• Displays passion and optimism
• Inspires respect and trust
• Uses negotiation skills to resolve conflicts
• Adapts to changes in the work environment
• Maintains objectivity
• Changes approach or method to best fit the situation
• Displays original thinking and creativity
• Exhibits sound and accurate judgment
• Includes appropriate people in decision-making process
• Makes timely decisions
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
Education & Experience
High school diploma or equivalent, some college preferred. Five or more years of medical billing and/or collections experience preferred. Insurance, medical terminology, CPT, and ICD9/10 knowledge required.
Certificates, Licenses and/or Registrations
Medical Coding Certificate; RHIT or CPC by AAPC or AHIMA license; meet state licensure.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Has moderate to advanced computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Physical Demands & Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit and use hands for typing or calculating. The employee is frequently required to reach with hands and arms. The employee is occasionally required to stand and walk. The noise level in the work environment is usually moderate.