Medical Billing Specialist

• Completes billing/claims submissions to multiple payers on a weekly basis
• Maintain spreadsheets and documents for payer reimbursement as required.
• Serves as a resource regarding claims status. Communicates difficult claim situations and helps resolve issues.
• Corrects suspended claims with information provided by Program and/or Administrative Staff resubmits for payment.
• Maintain updated knowledge of the group’s contractual agreements and report any discrepancies in payors reimbursement patterns to the Billing Specialist in writing.
• Maintain updated knowledge of provider manuals and billing guidelines.
• Complete status reports weekly or as instructed.
• Reviews and Reconciles remittances weekly.
• Analyzes claim aging to resolve unpaid claims. Tracks claims until paid.
• Follow-up with payors regarding reimbursement claims in the following interval and status or as defined by management:
  • Claims that have received denials for erroneous reasons; follow-up initiated and completed within 10 business days or receipt of notification.
  • Claims that require additional documentation; follow-up initiated and completed within 10 business days or receipt of notification.
  • Claims that have not been acknowledged; follow-up initiated and completed within 10 business days after receipt.
• Initiate first and second level appeal, grievances, reconsiderations, redeterminations, and all categories of disputes required to secure reimbursement.
• Assist Billing Specialist with the hearing process to mediation.
• Meet assigned deadlines and communicate status with management.
• Assist with special projects as needed.
• All other duties as assigned.

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