We are looking for a responsible Medical Insurance Billing Specialist to perform a variety of insurance billing and clerical tasks for a multi-specialty medical practice.
Ensures billing operations are performed in an accurate and timely manner.
Evaluates billing processes and procedures and assists management.
Works with a team of medical billers, including insurance clerks, data entry clerks, and medical records.
*Duties:*
* The primary responsibility of the Specialist is to ensure proper follow-up is performed on the back-end aspects of the revenue cycle process related to reimbursement, including projects, problem and issues escalation, and research
* Handle collection of patient portions of bills (copays, deductibles, uninsured, etc), as well as collect reimbursement from insurance plans.
* Identify, investigate, and resolve all rejected, denied, and outstanding insurance claims.
* Outreach to patients to obtain missing insurance information and other demographic information.
* Coordinates with self-pay patients regarding outstanding balances.
* Perform A/R reconciliations and audit of claims to ensure compliance.
* A/R follow up, basic medical coding knowledge, and insurance verification/eligibility
* Versatility, flexibility, and willingness to work within constantly changing priorities with enthusiasm
* Maintain a strict degree of confidentiality in all areas relating to provider credentials, status and provider personal information.
* Update expired credentials as required by policies and state and federal regulations.
* Ensure all provider enrollment paperwork is complete and submitted to the appropriate parties in a timely manner.
Follow up with payers until the process is complete.
* Respond promptly to any and all provider or third party insurance payer requests or questions.
* Maintain electronic records of provider’s credentials, work history and payer enrollments.
* Process all requests to update provider demographic or practice information and forward to the appropriate third parties as necessary.
* Medicare Advantage and commercial contracts with a focus on quality measures.
This service-oriented position is knowledgeable in quality measures and familiar with approaches for reviewing electronic medical records to identify and submit documentation to address quality measure gap closure.
*Responsibilities*
* Utilize knowledge of quality measure specifications to aid in the audit and review of patient charts for quality measure information
* Conduct outreach to patients to address open quality care gaps; provide education and assist with determining the discrepancies between recommended best practices and the actual care provided
* Upload supplemental data to individual payor portals towards meeting contractual quality metric requirements and improving performance in quality incentive programs
* Assist patients with scheduling appointments and placing orders for the care they need to remain healthy
* Assist with quality performance improvement plans and efforts; execute health campaigns, participate in meetings regarding quality; generate ideas to improve quality performance.
*Other Duties and Responsibilities:*
Other duties and responsibilities or special projects as assigned.
Qualifications:
Must have a minimum of 2 years credentialing experience, knowledge of Medicare, Medicaid, and Commercial Insurance.
CAQH experience required.
Knowledge of managed care and/or health care concepts and terminology preferred.
Attention to detail.
Above average interpersonal, verbal and written communication skills.
High degree of organization and follow through.
Thorough knowledge of Microsoft Office applications and general computer literacy.
Job Type: Full-time
Pay: $12.
00 - $23.
00 per hour
Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
Schedule:
* Monday to Friday
Work Location: In person
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