Billing Specialist 1

Billing Specialist 1

Requirements

• High School Diploma or GED required
• Medical billing experience highly preferred
• Experience in billing software and electronic data submission preferred

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.

Preferred Qualifications

No preferred qualifications provided.