Summary: Submits medical insurance claims with commercial insurance carriers, Medicare and Medicaid, electronically, when possible, and by paper; posts insurance and patient payments to patients’ accounts. Verifies submitted charges with providers, if necessary, and assists patients in understanding charges and payments to their accounts. Performs denial management and follow-up on unpaid claims for resolution, in a timely manner.
Essential Duties and Responsibilities:
Core Values Statement
Patient Focused |
The patient comes first and is central to all decision making. |
Respect |
Treat all patients and staff the way you expect to be treated. |
Accountability |
Each employee owns their actions, and expects the same from all others |
Teamwork |
It is necessary to work together in a supportive manner to achieve common goals. |
Continuous Improvement |
Stay committed to the pursuit of excellence, always finding ways to adapt and improve. |
Integrity |
Always do the right thing. |
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position routinely deals with sensitive and confidential information requiring the utmost privacy and confidentiality.
Education and Experience:
A high school diploma is required, additional education/training desirable, and at least three years related experience and training in medical insurance claims filing, or equivalent, preferably in a financial-medical setting, or a combination of education and experience in financial-medical setting. Because insurance regulations and billing guidelines are ever-changing, continued education in CPT, HCPCS and ICD-10 coding, as well as payer updates is necessary. Position requires a minimum of 8 hours continued education either through payer website training, webinars, seminars or other form approved by MLMC management.
Computer Literacy:
Knowledge of practice management and electronic health record is essential. Ability to utilize online resource materials and payer websites for claim management also preferred.
Insurance Knowledge:
Vast understanding of the different types of insurances and the knowledge and ability to distinguish the differences in coverage, charges, co-pays, denial codes, and denials reasons. Understanding Federally Qualified Health Center or Rural Health Clinic reimbursement and billing preferred.
Work Record:
A demonstrated work record showing good attendance, punctuality, dependability and the ability to work well with supervisors and coworkers as part of a team effort is essential. A medical office setting is an environment that requires the ability to relate to all types of people while always maintaining a professional demeanor.
Language Skills:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals is essential. Ability to write routine reports and correspondence, and the ability to speak effectively to patients, co-workers and the public at large is paramount.
Mathematical Skills:
Must have the ability to calculate figures and amounts such as sliding fees, discounts, interest, proportions and percentages along with mathematical accuracy and attention to detail are essential skills for this position
Reasoning Ability:
Must be able to demonstrate the ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Team Work:
An essential element is the ability to work and interact effectively and positively with other staff members to build and enhance teamwork in the center and in the overall MLMC organization; team engagement is a must to be successful in this position.
Sensitivity to the Needs of Special Populations:
Must be able to demonstrate the ability to understand and respond appropriately, effectively and sensitively to special population groups served by MLMC. Special population groups include those defined by race, ethnicity, language, age, sex, sexual orientation, economic standing, disability, religion, etc.
Understanding of HealthCare laws and Regulations:
Must have the ability to follow HIPAA guidelines as well as an understanding of policies and procedures regarding medical records put in place by the Federal Government.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to drive, sit, handle papers, type and operate computer equipment; reach with hands and arms; talk, see and hear. Some local travel may be required.
Work Environment:
Work is performed in a typical business office environment and periodically at locations outside the office. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Job Description: Billing Specialist
I have read and understand this position description. I understand that while every effort has been made to describe the nature of the work entailed, this description cannot be construed as an exhaustive list of all responsibilities, duties and skills required for this position. I also understand this position description may be changed in the interest of better patient care or more efficient operation of the health center, and that notification of any change in this position description will be made in writing. I also acknowledge that nothing explicitly stated or implied in this position description alters the “at will” status of my employment relationship with Western Maryland Health Care Corp, doing business as Mountain Laurel Medical Center.
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