JOB OVERVIEW

 The Billing Specialist IIl is responsible for the accurate, timely and efficient submission of client claims and ensuring those claims result in full payment.  This position will interact with RCM clients consistently and must provide consistent and exceptional customer service while driving all discussions with data.

They must ensure accuracy and compliance in all record keeping allowing for an accurate billing process and financial close. As well as follow up promptly on unresolved issues to help ensure maximum collections for clients.

 RESPONSIBILITIES AND DUTIES 

• Preparing, reviewing and transmitting claims using billing software, including electronic and paper claims.
• Verify insurance coverage as needed to substantiate claim submission.
• Identify secondary and tertiary payers as needed.
• Follow up to ensure receipt by all applicable insurers and review unpaid claims within billing cycle timeframes.
• Review payments for accuracy.
• Coordinate consistently with clients to investigate and resolve denied claims and return corrected claims to the insurer quickly.
• Work with representatives of insurance companies (including Medicare and Medicaid) to resolve payment discrepancies.
• Detail oriented with solid verbal and written communication skills.
• Provide exceptional customer service to all clients.
• Comfortable with all levels of finance, admissions, medical records, and working with clinical representatives.
• Possesses strong analytical, time management, organizational, problem solving and decision-making skills.
• Must have a working knowledge of Medicare, Medicaid and be familiar with commercial insurance billing and their respective plans.
• Strong computer and billing software skills.

QUALIFICATIONS 

• High School diploma or general education degree.
• 3+ years of experience in one or more aspects of the medical revenue cycle management.
• 2+ years of account level customer service.
• Exceptional problem-solving abilities and attention to detail particularly as it relates to claim investigation, denials, appeals and collections.
• Knowledge of Microsoft Office Suite.
• Knowledge of insurance guidelines for all applicable players.

 INTERACTION 

This role will work closely with key departmental and project stakeholders across the organization.  Therefore, the ability to work collaboratively and effectively with all levels of management and staff within the organization is a key priority in this role. No supervisory responsibilities required for this position.

COMMUNICATION AND COGNITIVE ABILITIES 

• Cooperate with matrixed team members to meet goals or complete tasks.
• Must be comfortable working in ambiguous and/or stressful situations.
• Must be self-motivated and know when to seek guidance; detail-orientation is a must.
• Flexibility, ability to change priorities quickly, and capacity to handle multiple tasks.
• Effective collaborator with proven process improvement skills.
• Exceptional organization and time management skills.
• Excellent communication and interpersonal skills.
• Ability to consistently learn new technologies and apply those concepts to customer’s needs.
• Ability to work as part of a geographically dispersed team.
• Ability to work independently and as part of a team.
• Keep up to date on technology trends, developments & best practices.
• Ability to communicate effectively to both technical & non-technical audiences.

Note: This job description is not intended to be all-inclusive. Employee may perform other related duties as requested to meet the ongoing needs of the organization.