Medical Billing Specialist - Houston, TX or Franklin, TN

Posting Details

Job Details

Description

The Medical Billing Specialist is responsible for the timely and accurate submission of insurance claims, reviewing and updating denied claims for resubmission and performing reconciliations to ensure timely billing for services provided.

The Medical Billing Specialist collaborates with patients, revenue cycle counterparts and work units, clinical staff, and insurance providers to drive the efficiency of the billing process and reduce the amount of denied claims.

Essential Responsibilities :

• Reviews patient demographic and insurance information and confirms patient benefit details related to services provided by the clinic from insurance providers.
• Obtains necessary medical documentation from clinicians to provide to insurance companies as required for review and prior authorization of treatment.

Documents authorization reference numbers in EMR and / or other systems.

Updates and maintains EMR and / or other systems based on documentation provided by physician / clinic for creation of medical claim and / or posting of self-pay charges to patient accounts.

Prepares electronic claim files for submission.

• Monitors accepted / denied claims and updates claims as required for resubmission.
• Compares transaction reports with daily schedules to ensure timely billing of all services provided each month.
• Resolves and prepares paperwork for any credit balances and prepares statements for collection of outstanding patient balances.
• Performs daily charge capture functions as outlined by each Clinic in a timely and appropriate manner. This includes but not limited to the actual data entry of charges per patient into the EMR platform, eIVF.
• Ensures charge reconciliation to the schedule for all patients seen daily.
• Ensures appropriateness of charges based upon services rendered and works in conjunction with Clinic leadership, RCM Leadership, and Coding Team to ensure such accuracy.
• Additional responsibilities will be outlined in a more detailed job description during interview process.

Education / Experience :

• High School Diploma or equivalent required, Associate’s preferred.
• 1 - 2 years of medical billing experience required in a clinic / physician practice setting.
• 1-2 years of medical billing experience related to a lab and ASC setting also preferred.
• Versed in CPT code sets and requirements including but not limited to modifiers, CPT bundling / unbundling, proper diagnosis assignment, Evaluation and Management Codes, Lab Codes, and ASC HCPC code sets.
• Familiar with claim edits and clearinghouse functionality.
• Familiar with medical billing platforms utilized in clinic and physician practice settings.

What we offer you!

• Outstanding benefits including health, vision and dental packages, including HSA / FSA, Life and Disability Insurance
• 18 days of accrued PTO in addition to 11 paid holidays
• Fertility benefits
• 401(k) Retirement Plan with generous company match
• Team-oriented, collaborative work environment with internal growth opportunities
• Employee Assistance Program
• Continuing Education Reimbursement

Qualifications

Skills

Behaviors

Motivations

Education

Experience

Licenses & Certifications