Under the direction of the Director of Strategic Initiatives, the Advanced Modality Billing Specialist performs a variety of duties both clinical and clerical in nature. This position is responsible for aspects of billing, communicating with insurance companies, billing claims, interpreting payer remits, monitoring denials, writing appeals, and resolutions from participating insurance carriers and working proactively to collect payments from insurance carriers. Must have a working knowledge of basic office equipment, good phone and computer skills. It is also important that billing specialists follow all rules related to patient and employee confidentiality.
Job Responsibilities and Duties
Contact payer organizations to verify coverage and obtain prior authorization/per-certification of services, as needed.
Abstract information from medical record and assign appropriate codes as necessary.
Prepare and submit claims to third party insurance carriers either electronically or by hard copy billing.
Notify providers of all wound care consults.
Understand insurance benefits including copay's, deductibles and coinsurance.
Researches and analyzes denial data and coordinate denial recovery responsibilities.
Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials.
Identifies and pursues opportunities for improvements in denial performance
Assists with chart audits as necessary
Processes work lists to facilitate prompt intervention of insurance denials
Research rejections included in EOB's for resolution and files appropriately
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks
Responsible for various clerical functions related to the job.
Maintain confidential records and files.
Type correspondence, reports and other documents.
Scanning, filing, and faxing documents.
Run and maintain eligibility throughout the month on applicable patients.
Performing other duties as required.
Excellent written and verbal skills are required as well as outstanding interpersonal skills
Able to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills.
Understanding of medical terminology required
Knowledge of CPT, HCPCS, and ICD10 coding required.
Knowledge of medical billing and collection practices
Must have exceptional attention to detail
Self-motivated, self-directed, team oriented, and responsible, with a positive attitude and a proactive style. Possesses the ability to operate in a highly variable work environment.
Presents a courteous and competent demeanor to our clients and teammates.
Mobility and Lifting: Frequent sitting for extended periods of time; frequent standing; frequent lifting up to 25 pounds.
Visual: Constant ability to read information, including close up; constant ability to use a computer screen; frequent use of good overall vision, including color perception.
Dexterity: Constant eye and hand coordination and manual dexterity to write, operate a computer keyboard and finely manipulate small objects.
Emotional/Psychological: Constant ability to make decisions and concentrate.