The Billing Specialist is responsible to provide support to providers, coworkers and customers internally and externally on billing related inquiries. The employee works/reviews all claims prior to their submission using department guidelines and Athena.
Responsibilities & Standards:
- Demonstrate excellent interpersonal skills with patients, coworkers and insurance carriers.
- Well-versed with all HIPAA Guidelines to ensure the protection of patient information from unauthorized inquiries.
- Process and post payments when necessary
- Works hold accounts in Athena within a timely manner
- Resolve patient complaints within a minimal timeframe, same day whenever possible
- Meet timelines for reprocessing Athena claims after updating the account with new information as provided by patients or physicians within the guidelines and timeframes permitted by the insurance carrier
- Advanced knowledge of CPT codes and modifiers
- Phones answered & voicemails returned within same day
- Claim adjudication carrier rules knowledge
- Conducts themselves in accordance with Elite DNA Therapy Services Policies and Procedures including the Code of Conduct
- Meets or Exceeds monthly performance goals, expectations and reviews
- Uses Paid Time Off effectively
- Keeps overtime to a minimum/has any overtime approved by Director
- Actively participates in team meetings and educational opportunities
- Performs other duties as assigned.
- Must be responsible for the assignment of accurate ICD diagnoses, CPT, HCPCS, and modifiers.
- Able to abstract code from medical records, reports, and related patient documentation.
- Thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences.
- Requires understanding of how to decipher explanation of benefits and explain the impact to the customer.
Licenses and Certifications: None
- Proficient oral and written communications, and project management skills.
- Excellent attention to detail, problem-solving and customer service
- Ability to conduct telephone conversations with patients regarding account resolution and payment collection.
- Must demonstrate positive interpersonal relationship skills with individuals and groups in a wide variety of settings
- Insurance terminology knowledge essential
- Effectively uses Electronic Health Records
- Typing Skills