Medical Billing Specialist is responsible for handling all types of insurance claims, including private, Medicare and Medicaid. They are responsible for both patient and insurance collections and making sure claims are processed in a timely manner so that the organization is properly reimbursed for services provided. This includes working on follow-ups, denials, and refunds.
- Patient demographics and insurance verifications are confirmed
- Charge entry: All visits are checked for retrievable/appropriate ICD-9/ICD-10 and CPT codes, according to insurance guidelines.
- Approved visits are batched and sent electronically to the insurance company via clearinghouse. Paper claims might be processed for secondary insurances.
- Insurance Electronic Claim Submission and Response Reports are processed at least twice weekly.
- Insurance Denials, follow-ups, EDI file rejections, adjustments and aging
- Insurance Check postings
- Unapplied Credit/Refund requests for both patient and insurances
- Collections/bad debt for both patients/insurances
- Assist patients with billing questions, payments, etc. as needed via phone or in person
- Call insurance companies as needed to check on claims and patient eligibility
- Notify manager of any unresolved issues on real-time
- Help manager with assignments as needed
- Assist with coverage at Front Reception and Call Center as needed.
- Excellent customer service skills (internal and external) is a must. Establish and maintain effective working relationships with those contacted during the course of work.
- Knowledge of Centricity or other EMR/EHR and aptitude to learn Centricity
- Must be detail-oriented
- Must be able to prioritize tasks
- Must be able to meet monthly deadlines
- Must be able to work in a team setting.
- Understand of Current Procedure Terminology (CPT), ICD9 /ICD10 coding and the billing procedures for Medicare/Medicaid, Workers Compensation, HMOs, PPOs and other managed care and commercial insurance plans
High School Graduate or Equivalent
Certified Professional Coder, preferred but not required
Two to five years’ experience in an FQHC or similar setting required
Three years’ experience in a nonprofit healthcare setting
Knowledge of CPT Codes, ICD 9/ ICD 10
Familiarity with various computer software (i.e. Excel, Word Perfect, Word)
Experience with computerized practice management/billing systems
Requires good verbal and written communication skills. Must be able to speak and read the English language. Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twenty (20) pounds without assistance. Work is primarily facility-based in an outpatient ambulatory care clinic. May require attendance at offsite meetings and events.
Blood borne pathogen exposure risk
Category III: Job Classification includes those employees who perform jobs and tasks where NO CONTACT with blood borne pathogens occurs and Category I and Category II tasks ARE NOT a condition of employment.
Limitations and Disclaimers:
The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for this position. All job requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.
This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor or other clinic management in compliance with Federal and State laws.
Requirements are representative of minimum levels of knowledge, skills and/or abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Continued employment remains on an “at-will” basis.
The mission of the Norwalk Community Health Center is to provide high quality, comprehensive primary health care to the people of the City of Norwalk and the surrounding towns regardless of the ability or inability to pay. Our staff at NCHC will treat each individual with respect; we are dedicated to improving the health status of every patient. We are committed to treating each patient with the care and concern we would want for our families and ourselves.