Medical Billing Specialist

• Verification of Benefits

• Verify insurance benefits including coverage, co-pays, and deductibles via AthenaOne auto-verification, or via the internet or phone manually if required, for all new patients and again prior to all follow-up visits.
• Clearly communicate insurance coverage status (co-pays, deductibles, etc.) to the front desk team so that patients and families understand and agree to their coverage for our services.
• Claims Processing

• Prepare and submit clean claims to insurance payers using AthenaOne automated platform.
• Review insurance remittance advice and rebill as applicable
• Evaluate payments/denials received for correctness and ensure they are applied accordingly.
• Detect any overpayments and/or duplicate payments and investigate and resolve accordingly.
• Process refund requests, in accordance with policies and procedures.
• Resolve issues that caused a denial within 5 days of receipt of denial.
• Revenue Cycle and Patient Account Management

• Regularly review outstanding patient accounts for resolution, recommend and submit write-offs, process refunds and adjustments as applicable, provide status updates on delinquent accounts, issue collection letters, and make collection calls as necessary, in accordance with established policies and procedures.
• Ensure accurate addresses are maintained in the billing software to send monthly statements.
• Perform all applicable month-end close duties to ensure the accuracy of data and claims.
• Consistently look for areas to maximize claim reimbursement.
• Internal Assistance with Credentialing

• Help to review and maintain payer contracts
• Work with credentialing specialists to update and add new providers to payer contracts as required
• Review and maintain provider information up to date in registries (CAQH, NPPES, PECOS, state licenses, DEA, etc.)
• Quality Care

• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
• Maintain a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
• Ensure that the collection operations are conducted in a manner that is consistent with overall department protocol and follows Federal, State, and payer regulation, guidelines, and requirements.
• Recognize and support patients' rights and responsibilities in the performance of job duties, while respecting their privacy and confidentiality.
• Ad-hoc Tasks: be prepared to undertake other related tasks as they arise, demonstrating flexibility and a team-oriented mindset

• A high school diploma or general education degree (GED) equivalent.
• Demonstrated excellence (at least 3 years experience) in medical billing.
• Some credentialing experience is a plus.
• Experience with AthenaOne EMR/billing software is preferred.
• Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
• Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
• Strong work ethic with personal qualities of integrity and credibility.
• Self-directed, detail-oriented, conscientious, organized, and able to follow through.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.

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