Medical Billing and Appeals Specialist - Hybrid

Advanced Pain CareAustin, TX, US

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Job Description

Description :

REMOTE - this position will be fully remote after training.

Texas residents only

Job purpose

The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and / or non-payment.

Duties and responsibilities

Reviews and appeal unpaid and denied claims

Attaches appropriate documents to appeal letters

Researches and evaluates insurance payments and correspondence for accuracy

Logs appeals and grievances, and tracks progress of claims

Keeps up-to-date reports and notates any trends pertaining to insurance denials

Calls insurance companies to inquire about claims, refund requests and payments

Manages Accounts Receivable reports for the Billing Department

Utilizes EMR system to submit and correct claims

Posts patient and insurance payments

Sends paper claims to insurance carriers

Answers patient billing questions

Coordinates medical and billing records payments with patients and / or third-party payers

Handles collections on unpaid accounts

Identifies and resolves patient billing complaints

Answers phone calls to the Billing Department in a timely and professional manner

Processes credit card payments over the phone and in person

Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements

Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments

Operates standard office equipment (e.g. copier, personal computer, fax, etc.).

Has regular and predictable attendance

Adheres to Advanced Pain Care’s Policies and procedures

Performs other duties as assigned

Requirements : Qualifications

Education : Requires a high school diploma or GED

Experience : Three or more years related work experience of training

Knowledge, Skills and Abilities :

Clear and precise communication

Ability to pay close attention to detail

Effectively manages day by organizing and prioritizing

Possesses excellent phone and customer service skills and abilities

Protects patient information and maintains confidentiality

Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding

Familiarity with analyzing electronic remittance advice and electronic fund transfers

Experience interpreting zero pays and insurance denials

Competence in answering patient questions and concerns about billing statements

Organizational skills and ability to identify, analyze and solve problems

Works well independently as well as with a team

Strong written and verbal communication skills

Interpersonal / human relations skills

Working conditions

Environmental Conditions : Medical Office environment

Physical Conditions :

Must be able to work as scheduled – typically from 8 : 00 – 5 : 00 M-F

Must be able to sit and / or stand for prolonged periods of time

Must be able to bend, stoop and stretch

Must be able to lift and move boxes and other items weighing up to 30 pounds.

Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.

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Medical Billing Specialist • Austin, TX, US

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