Specialist, Physician Billing

Status

Full-Time

Standard Hours per Week

40

Job Posting Category

Finance

Job Posting Description

Position Summary
The Physician Billing Specialist is responsible for the timely and accurate submission/collection of all physician claims assigned and is required to bring issue/problem identification and investigation through to an accepted/successful resolution. The Specialist will work with the Billing team to ensure the daily workflow is complete and that all assignments are reviewed, submitted, and resolved with the highest degree of accuracy, which may involve a high level of complexity. This individual should have the ability to take responsibility and perform required tasks independently as well as in a team environment.

We are seeking a detail-oriented and experienced professional with a strong background in surgical professional billing. Responsibilities include researching and resolving denied claims and preparing appeals to insurance companies. The ideal candidate will demonstrate a thorough understanding of payer requirements, documentation standards, and billing regulations specific to surgical procedures, while working closely with clinical, coding, and management team to resolve billing issues efficiently.

Prior EPIC  PB Resolute is preferred.

Key Responsibilities

• Engage patients or guarantors to resolve billing issues or guarantor responsibility as needed. Responds to inquiries received via telephone and other correspondence for patients/guarantors, insurance carriers, departments/foundations as needed.
• Provides positive and effective customer service that supports departmental and enterprise operations.
• Meets and exceeds short and long-term goals and objectives as established for the work unit. Demonstrates the ability to function independently, shows initiative, and is creative to continuously improve services, processes, and other activities that affect quality and productivity.
• Identify, trend, and communicate effective recommendations for resolution of issues or problems relative to work assignment for department process improvement. Acts as lead for special projects and assignments as identified by management or department on an as-needed basis.
• Acts as Subject Matter Expert to management and department related to assigned work while leading or participating in the training of new hires and experienced staff in routine and complex billing practices and procedures.
• Participates in process improvement opportunities. Identifies trends and communicates effectively recommendations for resolution of issues or problems related to work assignment for department process improvement.

Knowledge and Skills

• Ability to perform at a high level of reliability in all duties.
• Applies critical and strategic thinking.
• Advanced ability and knowledge of electronic claims processing, electronic remittance advice, electronic payment posting, and clearinghouse functions.
• Advanced knowledge and understanding of benefits and/or coverage as indicated by third-party payer requirements.
• Ability to identify problems and issues of varying complexities and to find effective solutions with few guidelines.
• Takes responsibility in anticipation/prevention of issues from actions and problem-solving inside and outside the department.
• Strives to continuously improve services, processes, and other activities that affect quality and productivity.
• Ability to take initiative to complete complex assignments.
• Exemplifies professional integrity.
• Ability to train and support other team members.

Education

• High School Diploma/GED

Experience

• 4 years of experience in a multi-specialty physician billing or equivalent medical billing experience

Office/Site Location

Westwood

Regular, Temporary, Per Diem

Regular

Remote Eligibility

Part Remote/Hybrid

Pay Range

$22.35-$35.76 Hourly