Job Description

Job Description

Job Description

Description:

Job Title: Billing Specialist

Position Summary

The Billing Specialist is responsible for demonstrating knowledge and application of job duties within scope of practice and functions under the direction of his/her manager(s) and/or Director(s); respectfully interacts with all levels of staff; provides assistance, as needed, during assigned duty hours; participates in department activities; promotes independence; adherence to the attendance policy; encourages socialization; advocates for the quality of life of our patients while maintaining compliance with all applicable laws, regulatory and organizational standards; supports the company’s core values.

Summary of Duties and Responsibilities

• A/R follow up
• Review claims and identify why insurance has denied
• Appeal denials
• Review, understand and apply information from medical records
• Re-Submit claims paper and electronically
• Review payer rejections and make appropriate adjustments
• Review and correct level two claim submission rejections

Summary of Duties and Responsibilities

· Complete daily charges as assigned by your team manager

· Ensuring charges are entered correctly with modifiers and ICD 10

· Knowledge of CPT and ICD 10 criteria

· Assisting other team members with ensuring all charges are completed within scheduled timeframe

· Assisting in submitting both paper and EMC claims

· Assisting with secondary paper claims

· Knowledge of rejection codes and denials

· E/M chart reviews and 2021 E/M guidelines

· Other responsibilities as assigned by management team

· Communication with providers, clinical, shot room staff and front staff as required.

· Documentation of all charge inquiries in patient chart

Abilities, Knowledge and Skills

Effective communication skills to include:

1. Ability to fluently speak and read English

2. Ability to read and interpret documents such as safety rules, handbooks, policies and manuals

3. Ability to communicate effectively, verbally and written, with all levels of staff and patients

Education, Prior Work Experience, Special Skill And Knowledge Requirements

· High School Diploma or GED required

· 1-year medical billing office experience preferred

· Availity clearinghouse experience, preferred

· Basic computer skills

· Understanding of deductibles, copays, coinsurance, etc.

· Excellent customer service

· Excellent verbal and written communication

· Well organized with an ability to meet deadlines

· Ability to multi-task and work in a fast-paced environment

· Strong analytical and problem-solving skills

· Medical Terminology ICD-10

· Self-driven with ability to work in a team environment

· Knowledge of insurance carrier guidelines

· Ability to read medical records, medical documentation and apply to claims being submitted to payers

· Strong verbal and written communication skills

· Acceptable results on Office of Inspector General, State Medicaid Exclusions, Abuse Registry Checks, Background Screenings, Drug Screen, and Sanction Checks.

· Must be at least 18 years of age

Physical Demands and Work Environment

Physical Demands

The physical demands described, here, are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the physical demands.

1. While performing the duties of this job, the employee is required to use hands to handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear.

2. The employee frequently is required to stand, walk, stoop, kneel, crouch, reach, push, pull, bend and sit. On average, billing staff may be sitting 80% of their shift.

3. The employee must occasionally lift and/or move up to 30 pounds.

4. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

5. Specific communication abilities required by this job include the ability to talk and hear in order to converse with others, discern, convey, express oneself, and exchange information.

Work Environment

The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job.

1. The noise level in the work environment is usually moderate; lighting is in the standard range.

2. The employee is subject to infectious waste, potential exposure to allergens in concentrated forms, diseases, and conditions.

EEOC Compliance

Family Allergy & Asthma provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color,

religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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