Medical Billing Specialist

Department/Unit:

Patient Billing Service

Work Shift:

Day (United States of America)

Salary Range:

$49,763.00 - $69,668.00

The Medical Billing Specialist is a higher-level billing role within the Hospital or Physicians Billing Offices for the Albany Med Health System (AMHS). This role is centered predominantly around denials. The incumbent will be expected to understand and resolve the most complicated of denials and/or will research the denial to learn what is needed by the payer. The incumbent must be able to work independently but also serve as a resource to others in the department. This position will act as a learning partner or mentor to the team. They will exemplify the meaning of teamwork and support their co-workers in a positive environment. This position will also possess the ability to manage assigned projects and present findings with preferred resolutions to leadership. This role will become familiar with running reports out of Epic as assigned. The incumbent will be expected to work independently and meet production standards. Progressive communication with peers, trainers, and leaders will also be imperative to success.

Essential Duties and Responsibilities

• Primary Job Responsibilities
  • Resolve all levels of denials. The more complicated denials may require research and outreach to understand what is required to resolve.
    Professional appeal submission with supporting documentation. This may also require second level appeal submissions which will require stronger reasoning and or additional documentation.
  • Identify and present the payer trends amongst the claims that are denying. Communicate and work with the leaders to mitigate. The expectation is that this role can work all denials and will serve as a resource to their peers.
  • Collaborate professionally internally or with external departments when needed to resolve the edit or denial. This may require consistent communication with coding or individual departments. For those that have coding certifications, the collaboration with Coding will be complementary and beneficial to both areas.
  • Present appropriate accounts for payer agendas with clear rationale and supporting documentation.
  • Ability to be the learning partner for peers. Supportive and positive demeanor when mentoring.
  • Manage and complete assigned projects timely. Present findings to leadership with suggestions to improve the process.
  • Proper and detailed notation of actions taken on the account. Others will rely on those notes when taking the next step on the account follow up.
  • Payer Website navigation as needed to obtain information. Review, understand, and locate payer policy guidelines as required. Ability to locate claim adjudication details with the supporting documentation.
  • Proficient use of Epic, OnBase, and other platforms as needed. Introduction and proficiency in running Epic reports will be required.
  • Ability to work independently and under time constraints and deadlines and with minimal supervision. Able to prioritize workload in an effective manner. Bring resolutions to management.
  • Meet daily/weekly productivity standards with acceptable QA results.
  • Other duties as assigned.
• Revenue Cycle Management
  • This position will present accounts that need to be placed on the payer agendas as they are not being resolved through the normal dispute process. The accounts are aging on the accounts receivable.
  • Identification and communication of payer trends that are negatively impacting the overall AR.
  • Timely and professional communication with outside departments to resolve the billing or follow-up challenge. Consistent and responsive communication with Patient Access and Coding are a must.
  • Identification of department trends and solution proposals to be presented to Management to address with the departments. Required participation in meetings to resolve. These could include practices, hospital departments, as well as departments within the revenue cycle.
  • Ownership of the more complicated accounts and mentor staff so they can understand and identify what is needed for these accounts.
  • Ability to create custom reports in Epic as required.
  • Suggest, outline, and collaborate with leadership to update policy and procedures (workflows) as needed
  • Increase knowledge and efficiency within the department.
  • Increase contract knowledge and calculations on the accounts. Begin to collaborate with the Contract Variance Team on accounts.

Qualifications

• High School Diploma/G.E.D. - required
• Associate's Degree - preferred
• 2+ years medical billing experience - required
• Strong Epic Resolute billing experience - required
• Ability to work indep