Medical Biller Specialist

JOB TITLE:

Medical Biller Specialist

SUPERVISOR:

RCM Manager

GENERAL JOB DESCRIPTION

Sterling Medical Billing Specialists are responsible for the insurance billing process between the medical office and insurance companies, federal agencies and third-party payers. They will be responsible for auditing patient accounts to ensure procedures, charges and coding are done accurately. Collection and posting of payments from commercial insurance companies, state and federal agencies and patients is a daily task.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Oversees the day-to-day operations of the clinic’s A/R collector function.

2. Operates within financial policies, procedures, and budget with effective use of resources.

3. Ensures compliance in federal, state, and other regulations including corporate, compliance licensure, safety, and security as relates to general office operations.

4. Reviews and reports any missed revenue opportunities.

5. Communicates and educates providers, administration, managers, and staff on coding or any documentation guidelines, rules and regulations that may impede claims payments.

6. Assists with denials and appeals from insurance payers.

7. Assists with charge entry, patient demographics, registration, collections, and other insurance/billing functions.

8. Oversees patient account collection processes and assists collectors in processes.

9. Oversees reconciliation of daily deposits, lockbox deposits, and EFT received.

10. Monitors aged balances of all accounts and ensures that delinquent accounts are followed up on as well as manages rejections and denials from co. claims clearinghouse.

11. Coordinates the payment process and collects payments from insurance companies, federal and state agencies, and third-party payers.

12. Stays informed about changes in Medicare and Medicaid.

13. Responsible for contacting the appropriate agency/company to resolve account collection problems.

14. Works independently to resolve account problems. 

15. Communicates to their office manager those accounts that need to be sent to the collection agency after all collection efforts have been exhausted by the medical office.

16. Adjusts patient’s bills to reflect credits, debits, and balances.

17. Collects balance due from patients when appropriate according to policy and procedure.

18. Documents all correspondence and conversations with insurance companies, governmental agencies, third party payers, and patients on patient’s accounts.

19. Stays informed of changes in the insurance industry.

20. Will maintain education requirements with the EMR system by completing the Front Desk Staff Training and Billing Training Professionals Training. A validation form will be downloaded for each module, the training videos watched, the supplemental materials done along with the deep dice topics and work comp and Occ Med. This will be done every 6 months and the validation form will be sent to human resources to be stored in the employee file.

MINOR DUTIES AND RESPONSIBILITIES

1. Meets dress code standards; appearance is neat and clean.

2. Completes annual educational requirements.

3. Maintains regulatory compliance.

4. Always maintain patient confidentiality.

5. Reports to work on time and as scheduled.

6. Attends annual review and performs in-services regarding compliance issues.

7. Works at maintaining a good rapport and cooperative working relationship with physicians, departments, staff, and Governing Body.

8. Represents the organization in a positive and professional manner.

9. Ensures compliance with policies and procedures regarding department operations, privacy, fire safety, emergency management and infection prevention and control.

10.  Complies with all organizational policies regarding ethical business practices.

11.  Wears identification while on duty; uses computerized time clock correctly.

12.  Attends a minimum of 10 staff meetings annually; reads and returns all staff meeting minutes.

13. Communicates the mission, ethics and goals of the facility, as well as the focus statement of the department.

QUALIFICATIONS FOR THE JOB

EDUCATION AND EXPERIENCE:

1. A minimum of five (5) years’ experience in a medical office is preferred.

2. Advanced working knowledge of billing operations, including charges, coding, payment, insurance claims, and appeals.

3. Current knowledge of CPT, HCPCS, and ICD-10-CM coding.

4. Working knowledge of methods, procedures, regulations and guidelines in patient and pay billing.

5. Current knowledge of insurance payer coding and reimbursement guidelines.

6. Working knowledge and experience in health information system management, including billing and medical record applications as well as claims clearinghouse.

7. Proficient organizational skills, attention to detail and accuracy.

8. Demonstrated ability to establish and maintain effective working relationships with internal and external parties.

9. Excellent interpersonal and communication skills to foster collaboration.

10. Ability to project a professional image.

11. Demonstrates critical thinking skills. Thinks independently, professionally, and ethically.

12. Knowledge of regulatory standards and compliance requirements in addition to departmental policies and procedures.

13. Working knowledge and ability to apply professional standards of practice in job situations.

14. Maintain appropriate professional composure in high stress situations.

15. Working knowledge of personal computer and software applications used in job functions.

16. Ability to communicate effectively in English, both verbally and in writing.

17. Excellent customer service skills.

18. Additional languages preferred.

OTHER QUALIFICATIONS:

1. Excellent computer knowledge and skills in working with spreadsheets, data entry, internet/intranet, etc.

2. Ability to use all office equipment.

3. Able to type 60-70 words per minute, accurately.

1.   Ability to work at a computer desk for a majority of the shift including the ability to use a keyboard and mouse for the required scheduled hours unless documentation of a medical disability has been provided.

2.  Ability to withstand hours of screen time.

3.   The ability to sit or stand for extended periods of time.

4.  The ability to lift and move boxes weighing up to 25 pounds.

KEY COMPETENCIES

1.  Sterling Medicals billing specialist will have strong communication and interpersonal skills. As a billing specialist, interaction will be with a variety of individuals to include patients, health insurance providers, other healthcare providers and other members of the healthcare team. Difficult conversations are part of their workday. The billing specialist always remains patient and courteous in difficult times.

2.  The ideal billing specialist should be good at solving problems. They should have an analytical mind with an eye that provides keen attention to detail. They should be fluent with procedures in processing claims to ensure timely and accurate payment for the services provided.