The Sr. Medical Billing Specialist is responsible for taking all steps necessary to achieve complete account reconciliation. Helps create policies and procedures along with training guides for new staff.
Essential Duties and Responsibilities include the following.
- Possesses and applies a thorough knowledge of the practice management billing systems and the ability to apply the knowledge to all aspects of the patient account including insurance, billing and collection
- Possesses and applies knowledge of CPT and ICD9 coding usage.
- Obtains all necessary information for completing the billing process, including charge information from the physician.
- Generates and submits collection notices and follows up on all patients due collection levels. Makes determination of possible assignment to outside collection agencies by complying with self-pay and bad debt policies.
- Actively works through any denied claims and actively gathers any needed information to take the proper action to ensure the claim is paid. Facilitates any appeals need to by correcting the claims or facilitating an appeal.
- Proactively researches and understand payer issues to troubleshoot the front-end processes that cause the denied claims.
- Identifies coding errors and insures that charges are properly bundled or unbundled. Understands the coding requirements for the governmental and commercial payers.
- Proactively identifies any changes in billing requirements to any governmental and commercial payors. Keeps the practices and billing office staff up to date with these changes.
- Monitors the accounts for any registration / front end errors and makes the supervisor and practice informed of repetitious ones as well as assists with training the practice to reduce these type errors.
- Actively works claims that show no response back from the insurance by running reports and following the necessary steps to ensure that the claim gets processed.
- Promptly answers inquiries from patients, co-workers, and supervisors regarding patient accounts in a kind and courteous manner.
- Identifies credit balances caused by posting errors and or insurance / patient overpayments.
- Assists in developing training guides along with training and orientation for employees.
- Assists with establishing billing and collection policy and procedures.
- Posts and balances all payments, adjustments and denials received on EOBs or ERAs in an accurate and timely manner. Reports any unidentified payments to the audit control coordinator.
- Promotes and maintains harmonious and effective relationships while communicating within the department and between the department and other areas
- Performs other duties as assigned or requested.
Supervisory Responsibilities
None
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Competencies
- To perform the job successfully, an individual should demonstrate the following competencies.
- Project Management - Completes projects on time and according to budget.
- Technical Skills - Strives to continuously build knowledge and skills; Shares expertise with others.
- Customer Service - Responds promptly to customer needs.
- Interpersonal Skills - Maintains confidentiality.
- Oral Communication - Responds well to questions; Participates in meetings.
- Written Communication - Presents information and data effectively.
- Teamwork - Balances team and individual responsibilities; Contributes to building a positive team spirit
- Quality Management - Demonstrates accuracy and thoroughness.
- Business Acumen - Understands business implications of decisions.
- Cost Consciousness - Works within approved budget; Develops and implements cost saving measures; Contributes to profits and revenue; Conserves organizational resources.
- Diversity - Promotes a harassment-free environment.
- Ethics - Keeps commitments; Works with integrity and ethically; Upholds organizational values.
- Organizational Support - Follows policies and procedures.
- Judgement - Exhibits sound and accurate judgement; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles.
- Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Organizes or schedules other people and their tasks appropriately.
- Professionalism - Reacts well under pressure; Accepts responsibility for own actions; Follows through on commitments.
- Quality - Monitors own work to ensure quality.
- Adaptability - Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
- Dependability - Keeps commitments; Commits to long hours of work when necessary to reach goals.
Education and/or Experience
High school or equivalent with 5 years of medical billing experience
Language Skills Ability to read, analyze, and interpret general governmental regulations. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Reasoning Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills To perform this job successfully, an individual should have knowledge of EMR systems, Excel Spreadsheet software and MS Word Processing software.
Certificates, Licenses, Registrations Clinical license and certification preferred, but not required.
Other Qualifications None Required
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to stand or walk; use hands to handle, or feel; reach with hands and arms, stoop, bend, kneel, and/or crouch. The employee must frequently lift supplies and/or equipment and may be responsible for lifting, positioning, and/or transferring patients.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet to moderate. The employee may be exposed to infectious or contagious diseases and a variety of electromechanical hazards. The employee may also handle emergency and/or crisis situations.
