Billing Specialist

Job Title: Billing & Payroll Specialist

Hours: Monday – Friday, 8:30 am to 5:00 pm

Job Type: Full-time

Reports to: Billing & Payroll Manager

Job Description: The medical biller is responsible for the timely submission of medical claims to insurance companies. Medical billing is very detailed oriented and requires a lot of attention. The medical biller needs to understand how to read medical records such as, the diagnosis code. He/she should be familiar with HCPCS Level II and ICD-10-CM codes. Also, the medical biller should understand how prior authorization and NPI numbers work. Medical billing consists of translating a healthcare service into a medical billing claim. The responsibility of the medical biller at T&N Reliable Nursing Care is to bill claims, follow the claims to ensure the practice receives proper reimbursement for the work the providers perform.

Job Responsibilities:

The essential functions for the Medical Biller include the following:

• Prepares and submits patient claims to appropriate third party payers
• Reviews claims to ensure that payer specific billing requirements are met
• Resolves routine and non-routine patient billing inquiries and problems
• Collects patient documentation for claim submission
• Ensures claim forms are completely and accurately filled-out
• Updates and maintains patient billing data and ensures documents are current
• Follow up on unpaid claims within standard billing cycle timeframe
• Contacts clinical staff for clarification on procedures or diagnosis and on missing information
• Updates billing software with rate changes and other appropriate information
• Follow up on denials
• Verifies and updates patient's insurance coverage
• Investigate and resolve any discrepancies
• Answers patient's billing questions
• Posting payments received from patients and third-party payors.
• Processes and obtains authorization requests for services (current and retro)
• Verifying the accuracy of Authorizations
• Using codes to bill insurance providers

• Learn and provide assistance to processing bi-weekly payroll.

• Familiarity with classification diagnosis and ICD 10 codes

• Familiarity with billing software such as Sandata, Paycom and others related to the field
• Keeping track of patient data over multiple visits
• Maintain patient confidentiality and information security
• Data entry ability
• Computer literacy and experience in MS word and Excel
• Ability to work well in a team environment. Being able to `prioritizes, delegate tasks if needed, and handle conflict in a reasonable fashion
• Ability to pull correctly reports out of software; paying attention to details.
• Effective communication abilities for phone contacts with insurance payers to resolve issues
• Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections
• Knowledge of medical terminology likely to be encountered in medical claims
• Ability to multitask