The Accounts Receivable Billing Specialist processes medical billing claims of low to moderate complexity, collects patient or provider payments, resolves account questions and issues, and processes patient refunds. The role also handles appeals, including redeterminations and resubmissions to patient payers for payment.
Responsibilities
- Respond promptly and appropriately to requests from management, staff, and providers.
- Maintain patient and physician confidentiality and professionalism.
- Scrub claims daily and submit them to the clearinghouse.
- Generate timely claim submissions to assigned payers.
- Follow department policies and procedures to ensure accurate and timely claim resolution.
- Review and analyze accounts receivable balances to ensure timely and accurate payments.
- Maintain accurate computer data and document all account activity.
- Follow up with insurance companies to resolve denials, corrected claims, and appealed claims.
- Bill coinsurance, deductible, and patient responsibility accounts according to payer guidelines.
- Review and respond to payer correspondence, including remittance advices, explanation of benefits, and denial letters.
- Communicate by phone, email, and internal processes to resolve billing and insurance issues.
- Document billing and payment status for future follow-up and stay current on payer requirements.
- Answer patient billing questions, complete end-of-month reports, and handle service ticket requests.
- Review patient credits for resolution.
- Meet quality standards and participate in team meetings.
- Support additional projects and tasks as assigned.
Requirements & Qualifications
Qualifications
- Minimum of 1 year of medical insurance or healthcare billing and collections experience.
- Strong understanding of medical billing rules and regulations.
- Knowledge of billing, collections, payment posting, revenue cycle, third-party payers, Medicare, and Medicare Advantage.
- Familiarity with state and federal payer regulations.
- Working knowledge of CPT and ICD-10 codes, procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits, and appeal processes.
- Experience with billing software and electronic medical records; ECW experience preferred.
- Proficiency with PC and Microsoft Office, including Word, Excel, Outlook, and Teams.
- Detail-oriented, organized, and strong in analytical and problem-solving skills.
- Ability to work independently and as part of a team in a fast-paced environment.
- Strong written and verbal communication skills.
Location
N/A
Employment Type
Not specified
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago
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