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Fort Myers, FL

Medical Billing Specialist

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Description

Job Summary:

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. 

Requirements

Education/Training Level:

  • 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

Communication Skills:

  • 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

Technology Skills:

  • Effectively uses Electronic Health Records
  • Typing Skills

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