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Summary
The medical billing specialist performs complex clerical and accounting functions for patient billing, including verification of invoice information, maintenance of third-party billing records, and resolution of problems. Follows up on submitted claims and patient billing; resubmits claims or correct inaccuracies. May handle cash items and accounts receivable posting. Works with others in a team environment.

Typical Job Functions
• Processes billing to patients and third-party insurance companies.
• Maintains supporting documentation files and current patient addresses.
• Researches and responds by telephone and / or in writing to patient inquiries regarding billing issues and problems.
• Monitors submitted claims, follows up on unpaid claims, and initiates dialogue with insurance companies.
• Monitors insurance balances at 90-day, 120-day, and 180-day intervals.
• Prepare monthly A/R report for CFO review.
• Submit prior authorization forms to insurance companies.
• Resubmits claims to insurance companies as necessary.
• Performs a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions.
• Answers questions from patients, clerical staff and insurance companies.
• Identifies and resolves patient billing complaints.
• Evaluates patient’s financial status and establishes budget payment plans.
• Follows and reports status of delinquent accounts.
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
• Works in conjunction with the reception to ensure accurate billing.
• Oversee day-to-day billing team operations.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Performs miscellaneous job-related duties as assigned.

Knowledge, Skills, and Abilities
• Ability to arrange information or actions in a certain order or pattern
• Ability to apply general rules to specific problems to produce reasonable answers
• Ability to communicate effectively both verbally and in writing
• Ability to work as part of a group or team to accomplish a common goal
• Excellent organizational skills
• Proficient in ICD – 10 Codes
• Attention to detail

Minimum Qualifications
• CPC (Certified Professional Coder) Certification
• Two years of experience in billing

Preferred Qualifications
• Prior experience working in a Medical Office
• Prior experience working in the Insurance Industry
• Prior experience working with Advanced MD or other EMR system

Work Environment and Physical Requirements
Employees work indoors and are protected from weather and/or contaminants, but not, necessarily, occasional temperature changes. The employee is regularly required to sit and often uses repetitive hand motions.

Disclaimer
This position description indicates the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to the position.