Billing, Content Management Systems (CMS), HIPAA (Health Insurance Portability and Accountability Act), Insurance Claims, Maintain Compliance, Medical Billing, Medical Records, National Security Agency (NSA), Patient Confidentiality, Privacy Controls, Regulations, Time Management
The Billing Specialist is responsible for accurate and timely submission of medical claims, and follow-up with payers and patients. This role ensures compliance with HIPAA and payer regulations while supporting efficient revenue cycle operations.
Key Responsibilities
· Prepare, review, and submit clean claims to insurance payers (CMS-1500 and/or UB-04)
· Verify patient insurance eligibility and coverage
· Ensure accuracy of patient demographics, charges, and modifiers
· Submit claims electronically and track claim status
· Research claim denials and rejections
· Correct errors and resubmit claims in a timely manner
· Prepare and submit appeals with supporting documentation
· Generate and review patient statements
· Respond to patient billing inquiries professionally and clearly
· Maintain compliance with HIPAA Privacy and Security Rules
· Protect the confidentiality of all patient information
· Out of network billing preferred but not required
· Knowledge of Federal and State guidelines regarding NSA and TDI claimsA
America's ER & Critical Care