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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The primary responsibility of DCI is to perceive, initiate and provide comprehensive patient care. We serve society by providing care for patients with End-Stage Renal Disease. Our goal is complete patient rehabilitation. We recognize the patient as an individual resulting from his or her genetics, life experience, habits, beliefs, emotions; and as a member of his or her family and the community. The patient deserves the highest standard of care possible regardless of race, status or creed. The application of comprehensive care is on a personal level. We become acquainted with our patient as a person and seek to understand his/her problems and needs- physical, emotional, spiritual and social. Through a team approach, each staff member performs functions within his or her capabilities in his or her defined role based on the specific needs of the individual patient. Patient care is assessed, planned, implemented and evaluated with the consistent aim of improving care and finding more efficient and effective methods for delivery of care. Realistic goals which promote safe, therapeutically effective and individualized care for each patient are defined in the patient care plan. These goals adhere to quality standards of care within the framework of defined policies and procedures. The team strives to provide the highest quality of patient care possible through the utilization of available human and material resources.
There is, however, a further responsibility to which DCI is devoted. DCI was established as a non-profit corporation, hopefully to generate funds for research in order that the methods for treatment of ESRD patients might be improved. We are not content to dialyze the next group of patients in the same imperfect way that the last group was dialyzed without at least making the attempt to better the patient's lot through research. As a corollary to this, education of ESRD health care professionals is another goal to which DCI resources are dedicated to support.
DCI's philosophy has always been a commitment to patients. Patients complete a financial profile which aides the social workers in directing them to community services to assist them. Patients are also assisted in acquiring and maintaining primary and supplemental insurance. If a patient does not have primary or secondary insurance, every effort is taken to find a DCI facility that can accept the financial burden of an uninsured patient.
DCI endorses the patient's right to choose the facility and the mode in which the patient's ESRD should be treated, i.e., dialysis or transplant. To help ensure that those patients desiring transplant may be offered this form of treatment, DCI founded and remains closely affiliated with DCI Donor Services, Inc., which operates independent organ procurement agencies and also contributes to research to improve patient access to transplantation.
We are a non-profit service organization. The care of the patient is our reason for existence.