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Medical Billing Specialist

Medical Billing Specialist

Primus OrthoTinley Park, IL, US
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Job Description

Job Description

Salary : Negotiable

The Medical Billing Specialist is a key member of the financial team at the Chicago Center for Sports Medicine & Orthopedic Surgery. This role is primarily responsible for ensuring accurate and timely processing of insurance payments, conducting appeals on improperly processed claims, and maintaining diligent follow-up on outstanding claims and denials. The Specialist will also assist with coding issues and patient inquiries regarding billing.

Key Responsibilities :

Payment Posting :

  • Accurately post insurance payments from mail batches and electronic funds transfers (EFT) from various sources, including websites and ECW EFTs.
  • Review and reconcile payment entries to ensure that all payments are accounted for and properly posted.

Claims Management :

  • Conduct thorough follow-ups on all outstanding insurance claims to ensure timely reimbursement.
  • Investigate and appeal underpaid or denied claims by gathering necessary documentation and submitting detailed appeals to insurance companies.
  • Proactively manage the Payer Denied Bucket by reviewing and resolving denied claims from commercial insurances.

    • Appeals and Rejections :

  • Handle mail batch rejections by reviewing the reason for rejection, correcting any issues, and resubmitting the claims.
  • Track the status of appeals by monitoring the appeal bucket and performing regular follow-ups until the appeal is resolved.

    • Coding and Compliance :

  • Assist with coding issues by reviewing and suggesting appropriate corrections to ensure accurate billing and compliance with medical coding standards.

    • Communication and Customer Service :

  • Respond to patient inquiries, providing clear explanations of benefits and answering insurance-related questions.
  • Ensure timely and professional responses to emails and voicemails related to billing inquiries.

    • Surgical and Commercial Billing :

  • Handle billing for surgical procedures, ensuring accuracy and completeness of all claims.
  • Manage commercial billing processes, including claim submission and follow-up.

    • Cross-Training and Collaboration :

  • Be cross-trained and serve as a backup for various billing positions within the department, maintaining the flexibility to support different functions as needed.

    • Administrative Support :

  • Complete actions and telephone encounters promptly, maintaining a high standard of patient service.
  • Participate in special projects and perform additional duties as assigned by supervisors or management to support the billing department.

    • Qualifications :

  • Associate or bachelors degree in finance, accounting, healthcare administration, or a related field is preferred.
  • Certification in medical billing and coding is highly desirable.
  • Minimum of 2 years of experience in medical billing, specifically in an orthopedic or similar specialty practice.
  • Proficiency with medical billing software, preferably ECW (eClinicalWorks), and a solid understanding of EFTs.
  • Knowledge of medical terminology, ICD-10, and CPT coding.
  • Strong analytical skills and attention to detail.
  • Excellent communication and customer service skills, with the ability to explain complex billing issues in understandable terms.
  • Ability to manage multiple tasks and prioritize work to adhere to deadlines and patient service standards.

    • The Medical Billing Specialist at Chicago Center for Sports Medicine & Orthopedic Surgery is integral to our team, ensuring the practice's financial health through meticulous billing management and exceptional patient service. If you have a passion for healthcare finance and a commitment to excellence, we invite you to apply.

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    Medical Billing Specialist • Tinley Park, IL, US

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