Medical Billing Specialist

JOB SUMMARY

The purpose of this position is to help in rendering service to the patient population. The Medical Billing Specialist must be flexible and able to multi-task. The position must also be knowledgeable as to how their job functions are integrated with the other members of the staff to produce a coordinated effort and insure teamwork.

JOB REQUIREMENTS

Minimum Education

§  High School Diploma or equivalent is required.

Minimum Work Experience

§  Prior Hospital Business Office, Physician Office or Insurance Company claims processing preferred.

Required Skills

§  Excellent phone communication

§  Computer skills

§  Typing skills

§  Must be very detail oriented

FUNCTIONAL DEMANDS

Physical Requirements

Sitting – Greater than 32%

Walking - 1-15%

Standing - 1-15%

Bending/Squatting - 1-15%

Climbing/Kneeling - 1-15%

Twisting - 1-15%

OSHA Category

Minimal Potential for Direct Body Fluid Exposure

Visual and Hearing Requirements

Must be able to see with corrective eyewear.

Must be able to hear clearly with assistance.

Other Physical/Environmental Demands

Lifting - 0-50lbs, 50lbs or more with assistance

Carrying - 0-50lbs, 50lbs or more with assistance

Pulling - up to 100lbs 

Pushing - up to 100lbs

LEADERSHIP CAPABILITIES

Supports the hospital Mission, Service and Values.

ESSENTIAL FUNCTIONS

§  Assist patients in obtaining payment for services rendered.

§  Provide positive customer service to the patients.

§  Works edits in the Soarian and Quadax Computer systems and releases claims to be transmitted electronically.

§  Print and mail paper claims with needed documentation such as itemized statements and/or medical records.

§  Monitor unbilled claims in Quadax. Update insurance information as needed.

§  Reviews accuracy of system edits and recommends changes.

§  Demonstrate competency in utilizing the various computer systems and programs within the Business Office .

§  Monitors the data quality obtained by Patient Access representatives

§  Bills secondary payors with documentation of primary payment.

§  Collaborates with other departments when necessary – Medical Records and Information Systems in particular.

§  Documents actions performed on each patient account appropriately.

§  Participated in payor education programs and meets on site with payor representatives.

§  Places calls to insurance companies and determines reason for claim not being paid.

§  Determine what is required to approve claims for payment. Work assigned worklist in a timely manner.

§  Visits insurance company web sites to determine claim status.

§  Provides data required by insurance company to process claims, including rebilling primary and/or secondary claims.

§  Submit requests for contractual adjustments as needed based on review of accounts.