Description
Medical Billing Specialist
Job Description:
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Analyzes, investigates and resolves account issues, including resubmitting and updating lien and claim document information.
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Accesses available resources, such as the Membership System, Resolute, Diamond payer databases to locate missing or incorrect information.
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Updates medical claims with corrected billing information and releases claims for transmission to the payer.
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Investigates and documents actions taken to resolve medical billing discrepancies and unusual charges and credits.
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Performs follow-up collection activity/negotiation of lien settlement via pre-assigned work queues to expedite payments.
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Works high priority TPL/MVA/WC cases according to department policies and procedures.
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Conducts research to make the determination of related (NON-Plan Services) paid claims for subrogation cases, which includes identification and validation of Third Party Liability/MVA/WC claims cost avoidance opportunities.
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Receives and responds to incoming correspondence and calls pertaining to TPL/MVA/WC verification, billing and collections inquiries from various sources.
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Evaluates case status based on established criteria, and takes appropriate action to maintain productive and proactive communication with the third party.
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Ensure that all appropriate patient service charges are entered into the billing system.
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Provides feedback and education to Financial Coders regarding coding and billing edits.
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Performs other duties as directed.
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Parking cost covered
Top Daily Responsibilities:
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Review medical charts
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Calls to validate information, insurance or attorneys
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Collection calls.
Requirements:
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1-5 years of medical billing/coding/collection experience (Manager's ideal candidate will have at least 2 years experience)
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Experience with Third Party Liability/Attorney collections.
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Experience with/knowledge of Workers Compensation and Third-Party Liability/MVA billing and collections, procedures and regulations.
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Knowledge of compliance medical and insurance terminology
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Knowledge of Microsoft Word, Excel, and Access.
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High school diploma or GED required. AA or BS preferred
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Coding certification preferred.
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Good communication skills
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Good customer service skills
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Someone who is able to work in a confidential environment.