Billing Specialist

Overview

Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution. 

Special Instructions

Responsibilities

• Promote the mission, vision, and values of the organization 
• Import charges from queues in a timely manner and append modifiers or any required information for claim transmission  
•  Review daily accounts that are ready to be billed in Waystar from Meditech 
•  Initiate correction on all claims with errors by the designated time 
• Follow up on any correspondence that may have been received on that day or the previous day 
•  Cross train on billing all lines of business to the different payers 
•  Pull listing of all accounts assigned to be follow up by specific payer 
•  Diagnostic and procedural coding 
• Follow-Up Responsibilities 
• Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies. 
• Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims. 
• Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts. 
• Maintain accounts receivable detail of their accounts through tasking. 
• Maintains standards per payer for percentage accounts >90 days. 
• Works minimum standard number of accounts per payer per day. 
• Meets or exceeds collection goals by payer each month. 
• Works all assigned accounts as assigned, depending on balance. 
• Complete appeals as required. 
• Participates in educational activities and attends monthly department staff meetings. 
• Maintains confidentiality: adheres to all HIPAA guidelines/regulations. 
• Other duties as assigned from time to time. 
• Attend educational activities and monthly department staff meetings 
• Perform other duties as assigned 

Qualifications

Required Education

• High School Diploma or GED required.

Preferred Experience

• Six (6) months of previous experience in clinic registration, billing and collections, financial counseling, or customer service preferred.

Required Skills, Knowledge, and Abilities

• Basic computer proficiency.
• Typing speed of at least 40 words per minute (WPM).
• Good written and verbal communication skills for effective account follow-up.

Preferred Skills, Knowledge, and Abilities

• Knowledge of medical terminology preferred.
• Familiarity with CPT and ICD-9 coding preferred.