Billing Specialist / Medical

Billing Specialist / Medical

Requirements

• High School Diploma/GED or equivalent required; some college a plus
• A minimum of 3 to 4 years experience in medical billing with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement; home infusion experience a plus
• Must have experience auditing documentation to insure compliance with payer requirements
• Working knowledge of automated billing systems, experience with CPR+ preferred
• Working knowledge and application of metric measurements, basic accounting practices, ICD-9, CPT and HCPCS coding
• Solid Microsoft Office skills, typing 40 wpm and proficiency with 10-key calculator
• Ability to independently obtain and interpret information
• Strong verbal and written communication skills

Responsibilities

• Ensure daily accomplishments work towards company goals for cash collections and Accounts Receivable over 90 days, Ready to Bill under 14 days, weekly and month-end close processes and other departmental goals as outlined.
• Understand and adhere to state and federal regulations and company policies regarding compliance, integrity, patient privacy and ethical billing practices.
• Manage the Ready to Bill queue on a daily basis; perform Quality Assurance to ensure accurate and timely creation of new claims and generic invoices; ensure submitted claims meet payer guidelines.
• Process confirmed tickets in “unworked” status within 48 hours of confirmation date; assign appropriate status to ensure proper handling by branch and billing personnel; make necessary demographic changes to reduce rejections of submitted electronic and paper claims.
• Work “resolved” unbilled tickets within 24 hours to “ready” or next status for resolution.
• Conduct billing utilizing most efficient resources to secure timely payment of open claims or invoices, giving priority to electronic solutions.
• Participate in branch Ready to Bill conference calls.
• Identify patterns of non-compliance by branch staff in completing patient registration, supporting billing documentation and delivery tickets.
• Review delivery tickets for accuracy and complete claims per payer-specific guidelines.
• Submit secondary billing in a timely manner with appropriate supporting documentation per payer specific guidelines to ensure expected revenue is allowed.
• Research websites of assigned payers to bill for payer updates and shares updates accordingly.
• Communicate consistently and professionally with other Amerita employees.
• Work within specified deadlines and stressful situations.
• Work overtime when necessary to meet department goals and objectives.

Preferred Qualifications

• Some college a plus
• Home infusion experience a plus
• Experience with CPR+ preferred