Medical Billing Specialist Pre Certifications

Description

GENERAL SUMMARY

The Medical Billing Specialist is responsible for coordinating all billing and collections. Specific duties to be performed include keying of charges and payments, ability to research unpaid claims, determine and correct cause, follow up as needed, submit appeals with supporting documentation according to the payer specific denial reasons and procedures and answering customer questions regarding their billing.

ESSENTIAL JOB FUNCTION/COMPETENCIES

• Responsibilities include but are not limited to:
•  Obtain prior authorization from Insurance carriers 
• Correct rejected claims and track payments.
• Follow up with patients and insurance companies regarding unpaid bills.
• Process patient data, including medical records and insurance-related information.
• Responsible for coding diagnoses, procedures, services, and treatments.
• Prepares To insurance companies for medical procedures and services
• Sends invoices to patients and insurers payment collection.
• Communicates with patients regarding outstanding balances and developing payment plans.
• Posts insurance and patient payments.
• Sets up payment plans for patient balances.
• Performs other position related duties as assigned.

Requirements

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

Coding and/or Physician Billing Certification, preferred.

KNOWLEDGE | SKILLS | ABILITIES

• Demonstrates understanding of business and how actions contribute to company performance.
• Demonstrates excellent customer service skills.
• Knowledge of medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD) coding, and revenue cycle process.
• Knowledge of EHR (Electronic Health Record) software systems and Microsoft Office products.
• Excellent verbal and written communication skills.
• Skill in using computer programs and applications including Microsoft Office.
• Ability to handle multiple tasks with excellent problem-solving skills.
• Well organized with the ability to maintain accuracy and confidentiality.
• Ability to work independently and manage deadlines.
• Complies with all health and safety policies of the organization.
• Complies with HIPAA regulations for patient confidentiality.

EDUCATION REQUIREMENTS

High School Diploma or equivalent required.

EXPERIENCE REQUIREMENTS

• Minimum of two years billing experience within a physician practice.
• Experience in prior authorizations.
• Experience in Urology or physician practice environment preferred.