The Medical Billing Specialist role involves all administrative and credentialing functions, billing, denial resolution, revenue collections, accounts receivable and third-party payer audits.
This also includes analyzing trends, adhering to regulatory compliance; implementing and managing the utilization of all insurance payers, clearinghouses and third party systems to manage and maximize cash flow.
The Medical Billing Specialist reports to the Controller.
EDUCATION and / or EXPERIENCE
Bachelor Degree in Accounting or five years related experience and / or training; or equivalent combination of education and experiences.
QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
ESSENTIAL FUNCTIONS
- Ability to manage Medicaid / Managed Medical Assistance (MMA) billing through various vendor portals and software applications
- Review patient bills for accuracy and completeness, and obtain any missing information from the Organization’s programs as assigned
- Collaborate regularly with appropriate department manager and departments to obtain provider credentials and services
- Establish follow-up for monthly claim submissions to manage revenue cycle
- Good Communication skills and a team-oriented mentality
- Ability to work with other billing and collections specialists to create a collective team
- Actively work to resolve disputed claims and maximize claim payments
- Manage collections monthly to ensure revenue collecting activities are completed to maximize cash flow
- Prepare breakdown of payments and reconcile remittance advices and review EOB(s) and EOP(s)
- Record revenues and payments to A / R systems for month-end reporting and closings
- Perform ongoing trend analysis of third party pending reimbursements and denials
- Improve revenue cycle throughout the organization, by working with appropriate departments, payers and vendors to aid in the resolution of identified revenue cycle issues
- Works with clinical departments to ensure that new initiatives and individual contracts are implemented and monitored
- Assist with organization fiscal year-end audit
- Actively participates in staff development, assessments and training to support industry best practices and trends
LANGUAGE SKILLS
Ability to read and comprehend simple instruction, short correspondence, and memos. Ability to write correspondence. Ability to effectively present information in one-on-one and small group situations to vendors, clients, and other employees of the organization.
CERTIFICATES, LICENSES, REGISTRATIONS
A Valid Florida Driver’s License
OTHER SKILLS AND ABILITIES
Strong assessment and documentation skills. Medical terminology background is preferred. Previous experience in Healthcare setting. Proficient in Excel.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit and use hands to finger, handle, or feel.
The employee must occasionally stand; walk; reach with hands and arms; stoop, kneel, crouch, or crawl; talk or hear. The employee must occasionally lift and / or move up to 25 pounds.
Specific vison abilities required by this job include close vison, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
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