GENERAL PURPOSE OF JOB

Responsible for working in our EMR alongside our billing team to help manage claim edits and errors, and resubmissions to our TPA’s on behalf of our clients.  The billing specialist will handle inbound calls to accept payments and answer all billing questions, while providing outstanding customer service to the patient.   

Schedule: Hybrid, must be located in the Sussex area

KEY RESPONSIBILITIES

• Assesses claims to verify correct billing 
• Completes assigned systematic checks to ensure all billable claims are transmitted and processed in a timely manor 
• Post remits from third party payers 
• Follows-up with insurance companies regarding denials of payment   
• Verifies all systems are balanced at the end of the date of service 
• Corrects, both preemptively and post submission upon denial or rejection, claims errors 
• Follows up on unpaid claims within the standard revenue cycle timeframe 
• Works collaboratively with management to identify system and TPA issues to evaluate trends 
• Maintains a solid understanding of current medical billing rules, laws and regulations 

SCOPE

Will work collaboratively with clinical, medical billing and coding staff, supporting health and wellness center-based staff as well as corporate staff based on client needs. 

JOB REQUIREMENTS

Education: 

• High school diploma  

Experience:

• Minimum one (1) year medical billing experience and a background in EPIC 

Knowledge, Skills & Abilities:  

• A working knowledge of insurance guidelines 
• Effective communication skills 
• Strong ethics and a high level of personal and professional integrity 
• A working knowledge of current medical billing, coding and collections rules and requirements 
• Ability to work in a team environment 
• Ability to work efficiently and maintain accuracy 
• A strong understanding of healthcare compliance to regulations including HIPAA, OIG, and AMA rules and guidelines 
• Proven ability to work successfully with diverse populations and demonstrated commitment to promote and enhance diversity and inclusion