Billing Specialist -US Healthcare

Job Responsibilities:

v Review and analyze patient encounter documentation to accurately assign appropriate medical codes (CPT, ICD-10, HCPCS) and modifiers

v Ensure the completeness and accuracy of patient demographic and insurance information for claim submission

v Prepare and submit claims electronically or by paper to insurance companies, adhering to billing guidelines and timelines

v Monitor claim status and follow up on outstanding claims to ensure timely payment

v Identify and resolve billing discrepancies, denials, and underpayments by communicating with insurance payers and following up on appeals and resubmissions

v Verify insurance eligibility and benefits to determine patient responsibility and coordinate with the patient for payment collection

v Collaborate with internal teams, including providers, coding specialists, and documentation experts, to address billing-related issues and ensure accurate claim submission

v Maintain accurate records of billing activities, including claims, adjustments, appeals, and resubmissions

v Provide exceptional customer service by responding to patient inquiries regarding billing, insurance coverage, and payment options

v Assist in the development and implementation of billing policies, procedures, and best practices to optimize efficiency and productivity

v Maintain compliance with HIPAA, HITECH, and PHI regulations applicable to the patient engagement setting.

v Support company or department tasks as assigned by management.

Minimum Qualifications:

· Proven experience as a Billing Specialist, Medical Biller, or similar role in a healthcare RCM setting

· Proficient in medical coding systems (CPT, ICD-10, HCPCS) and billing software applications

· Knowledge of healthcare reimbursement systems and insurance guidelines

· Familiarity with different insurance payers, including commercial, Medicare, and Medicaid

· Strong attention to detail and accuracy in coding and billing processes

· Excellent organizational and time management skills to meet deadlines and prioritize tasks effectively

· Strong analytical and problem-solving abilities to identify and resolve billing discrepancies and denials

· Effective communication skills, both verbal and written, to interact with insurance companies, providers, and patients

· Ability to work independently and as part of a team in a fast-paced environment

· Proficiency in using electronic health record (EHR) systems and billing software

· High School diploma or equivalent education (examples include GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)