Medical Billing Specialist

Overview

The Medical Billing Specialist assists the billing department to accurately manage patient payments and insurance claims. The specialist submits claims and/or encounters for clinical services to insurance companies, and other payers, to ensure proper reimbursement. Adheres to claim submission deadlines, posts payments and enters data into the electronic health record (EHR). Utilizes medical terminology, CPT coding, ICD coding, and HCPCS in relation to behavioral health services to process claims through the EHR. Performs quality assurance reviews to ensure clean claims are submitted. Maintains working knowledge of the State of Oregon's diagnosis requirements for billing behavioral health services under the Oregon Health Plan and the payment structure, to properly bill for services. Responsibilities are shared among individuals; one person will not have full responsibility for every duty.

Responsibilities

• Enters required billing data into the EHR.
• Creates and generates reports to extract and verify billing data.
• Organizes, prepares, and maintains detailed billing records, reports and files for billing department.
• Reviews and updates patient account charges, insurance data and demographic information in EHR software and researches missing or incorrect information that may affect claims submissions.
• Assists clinicians with coding questions and ensures coding errors are resolved so claims can be generated correctly.
• Bills primary and secondary insurance carriers within timely filing guidelines and departmental standards.
• Works with insurance representatives to problem solve denials or improper payments. Ensures claims are paid appropriately.
• Generates patient billing and ensures that these individuals have the necessary service approval status and fee agreement on file.
• Monitors the reconciliation of third party insurance remittances and cash application.
• Verifies clients' private insurance coverage and works closely with insurance providers to determine type of services covered.
• Processes month end close in the medical billing system and reconciles with agency's general accounting system.
• Reviews and corrects encounter data and Medicare billing exceptions.
• Maintains confidentiality, punctuality, attendance, and ethical conduct at all times.

Qualifications

• High school diploma or equivalent.
• Minimum of two (2) years of experience performing medical billing or a combination of related medical office experience and accounts receivable.
• Working knowledge of the State of Oregon's diagnosis requirements for billing preferred.
• Practice strong organizational skills, effective use of time and excellent communication.
• Use effective customer relations skills, including the ability to work with diverse people in a stressful environment, displaying an understanding of group dynamics and dealing with stress effectively.
• Possess business experience sufficient to meet the demands of the position, including proficiency with a variety of software applications.
• Must pass state-required background and DMV checks; Candidate must be able to work independently and flexibly, under general supervision.