The Physician Medical Billing Specialist is responsible and accountable for the capture, billing, and collection of charges. This includes billing, follow-up, and collections from patients and third party insurers.
Advises reception staff of need for updated demographics and acquires same from outside sources.
Captures, reconciles, posts, and submits charges by creating, reviewing, and sending billing form.
Communicates with providers regarding need for charge information.
Communicates with clinical office staff and accesses hospital information to get records when needed to support claims.
Transmits electronic claims, retrieves reports, and verifies transmission and receipt by clearing house and payer.
Runs reports of pending claims and reviews according to schedule and performs follow-up. Releases pending claims to patient responsibility per EOB’s and payment advisories.
Responds to written, phone, and electronic inquiries from patients and payers regarding claims and files secondary claims.
Prints and mails statements, performs collection calls, manages financial need determinations, and sets up payment plans where indicated.
Prepares letters of appeal on payment denials or insufficient payments.
Maintains a working knowledge of payer systems and requirements.
Notifies appropriate supervisor(s) of issues with provider’s participation with payers and / or credentialing status.
The qualified candidate must have knowledge of business office procedures and of medical procedure coding and claims forms completion and submission. They must also have a strong working knowledge and competency in use of computer systems. Must exhibit good people skills and be able to relate to people of and maintain effective working relationships with patients, providers, employees, payers, and the public.
Education, Licenses, Certifications and Experience Requirements:
High School education, with additional business school or computer training required.
Three years’ experience working with medical claims on an electronic basis is required.
Direct customer service experience helpful.
EMR/PM system-specific training will be provided by the EMR vendor.
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Job ID: 2019-9259
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