Career Level Mid Level (3-8 years)
Qualifications Degree Bachelor
> The medical Billing Specialist is responsible for entering medical charges, posting Insurance and patient payments, in a timely and accurate manner, denial and rejection management and account receivable follow up.
> Work directly with the insurance company, healthcare provider, and the patient to get claims processed and paid.
> Verifying insurance and benefits on behalf of the client and patient
> Check eligibility and benefit verification. Verifying receipt of all patient registration data from the client and notifying the client of potential insurance benefits problems.
> Prepare, review, and transmit claims post payments using billing software, including electronic and paper claim or ERA / EOB processing.
> Follow up on unpaid claims within the standard billing cycle time frame.
> Research and appeal denied claims.
> Meet individual and departmental standards about quality and productivity.
> Ability to handle protected health information in a manner consistent with the Health Insurance Portability and Accountability (HIPAA).
> Review patient bills for accuracy and completeness and obtain any missing information
> Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
> Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid. Decent knowledge of basic coding rules for billing. Should be able to help in registering to Insurance portals and EDI, ERA and EFT enrollment
> Responsibilities and Duties
> * Able to perform eligibility verification, precertification, with Insurance companies thru Insurance portals like Availity and over the phone.
> * Should be able to create manual claims or electronic claims from superbills in PMS
> * Ability to post ERA (Electronica Remittance Advice) & EOB (Explanation of Benefits) from various systems and websites.
> * Calling insurance companies and obtaining claim status with different payers & documenting it in the system.
> * Denial and Rejection management and Account receivable follow up
> * Ability to create efficient follow up system with all Insurance thru insurance portals.
> * Credentialing knowledge would be an added advantage
Job Types: Full-time, Part-time