Description

Summary of Role

The Medical Billing Specialist is responsible for managing the billing and reimbursement process at OAW. This role involves preparing and submitting claims to insurance companies, following up on unpaid claims, and ensuring accurate billing records. This role requires meticulous attention to detail, strong organizational skills, and a thorough understanding of medical billing procedures, codes, and regulations. The specialist will work closely with the medical staff, patients, and insurance companies to provide timely and accurate payment for services rendered.

Key Responsibilities

• Monitor and follow up on unpaid claims, ensuring timely reimbursement. Resolve billing and insurance discrepancies, rejections, and denials.
• Follow up on billing AR on no responses from payers. 
• Communicate professionally with patient inquiries regarding billing and insurance questions. Provide clear explanations of charges, insurance benefits, and payment options. Assist patients in setting up payment plans if necessary.
• Stay updated with current billing regulations, insurance guidelines, and compliance requirements. Prepare and maintain accurate billing records and reports.
• Work closely with coding team, authorization team and other departments to ensure accurate coding and authorizations.
• Communicate effectively with insurance companies to resolve issues and clarify billing information.
• Always maintain strict client and patient confidentiality. 

Requirements

Qualifications

• High School Diploma or equivalent
• Three or more years required experience in specialty insurance collections in a medical facility/practice or for a revenue cycle management company
• Minimum of two years of experience in accounts receivable is required 
• Basic understanding of medical terminology, CPT4, and ICD-10 coding. Revenue management systems experience.
• Experience using EPIC and Microsoft Office preferred. 
• Must be able always to maintain a professional attitude and confidentiality.
• Strong oral and written communication, and time management skills
• Ability to work in a team environment and confident interpersonal skills
• Familiarity with HMO, Medicare, Medicaid, commercial insurance guidelines, and medical terminology
• Ability to multitask in a high volume, fast paced working environment. 

Physical and Mental Demands

Communication Skills

Ability to clearly explain billing procedures, insurance details, and payment options to patients, as well as effectively communicate with healthcare providers and insurance companies. Accurate documentation of billing information and patient interactions. Strong interpersonal skills to handle patient inquiries and resolve billing issues in a professional and empathetic manner.

Mathematical Skills

Proficiency in basic math operations for calculating charges, payments, and adjustments. Understanding of billing cycles, insurance reimbursement rates, and payment plans. Ability to perform reconciliations and handle financial discrepancies. Ability to analyze billing data, identify trends, and detect errors or inconsistencies. 

Judgement and Decision Making

Ability to identify billing issues, investigate causes, and implement solutions. Prioritizing tasks based on urgency and importance. Evaluating complex billing situations, making informed decisions, and considering the potential impact on patients and the hospital. Ensuring all billing practices comply with legal and regulatory standards, maintaining patient confidentiality, and handling sensitive information responsibly. Ability to work under pressure, meet deadlines, and handle multiple tasks simultaneously. 

Software and Technology

Skilled in using medical billing software and electronic health records systems. Familiarity with coding software and tools. Accurate and efficient data entry skills for processing patient information, billing codes, and insurance details. Ability to learn and adapt to new technologies and software updates. Proficiency in using office software for documentation and reporting.

Work Environment

The primary work environment is hybrid-based. This position requires two days a week in the office and three days remote. The noise level in the work environment is usually moderate. Must be able to lift, push, pull up to 50 lbs.