Job Description

Billing Specialist I

The Billing Specialist I is responsible for collecting and entering claims, posting insurance, submitting claims, and answering patient inquiries on accounts. Reports to the Billing Supervisor.

Essential Duties and Responsibilities

• Enters information necessary for insurance claims such as patient, insurance, and insurance ID. Insures claim information in complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc. Resolves patient's complaints or explains why certain services are not covered.
• Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Follows HIPAA guidelines in handling patient information.
• May perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Understand managed care authorizations and limits to coverage such as number of visits.
• Verify patient benefits eligibility and coverage as needed.
• Prepares and submits secondary claims upon processing by primary insurer.

Standards of Behavior

• Integrity: I believe in being personally accountable for doing what is always right.
• Compassion: I believe in acting on the empathy felt toward the needs of patients and families.
• Innovation: I believe in being inspired to provide care in new and creative ways.
• Philanthropy: I believe in being a good steward of the gift of time, deeds and resources for our patients and community.

Job Qualifications

• Education: High School Diploma or GED required.
• Work Experience: Medical billing experience highly preferred. Experience in billing software and electronic data submission preferred.
• Certification/License: N/A
• Mental/Physical Requirements: Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds.

Working Conditions

• Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.

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