Medical Billing Specialist (65912)

Department: Billing

Position:  Medical Billing Specialist

Employee Category:  Non-Exempt

Reporting Relationship: Manager of Revenue Cycle Management

Character First Qualities:

• Decisiveness- The ability to recognize key factors and finalize difficult decisions.
• Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice.
• Flexibility- Willingness to change plans or ideas without getting upset.
• Patience- Accepting a difficult situation without giving a deadline to remove it.
• Tolerance- Accepting others at different levels of maturity.

Summary of Duties and Responsibilities:

The Medical Billing Specialist is responsible for reviewing daily charges and adjustments entered for accuracy, filing third-party claims, self-pay patient billing, and answering billing questions from patients and staff.

Primary Duties and Responsibilities: 

1. Reviews assigned claims daily to ensure accuracy prior to claim submission.
2. Reviews documentation on self-pay claims to ensure that the appropriate discount is applied.
3. Makes billing corrections and adjustments to claims as appropriate to ensure prompt payment and accuracy of balance.
4. Validates the correct payer for claim as well as verifies patient eligibility when in question.
5. Contacts patients for missing information or clarification of documentation.
6. Requests documentation and/or information required to process claims; scans and uploads documentation and information to patient accounts as applicable.
7. Submits claims to clearinghouse daily.
8. Processes secondary and tertiary claims accurately and timely to ensure payment.
9. Coordinates with the Claims Resolution Specialists to assist in investigating denied claims and credit balances.
10. Completes rejection and rebill requests.
11. Follows up on pending claims and work to resolution.
12. Assists with patient phone calls regarding balances and benefits; advises patients of deductibles and co-payment status.
13. Assists patients with payment arrangements by coordinating with a Collection Specialist. Issues individual statements when necessary on patient accounts.
14. Assists the front staff with bi