Medical Billing Specialist

General Summary of Duties: Under the direction of the Billing Manager, the Billing Specialist is responsible for the timely submission of claims to insurance companies from a wide variety of providers, as well as monitoring and ensuring payments for KMHS services are received timely.

The Billing Specialist will attempt to collect from assigned payers, including insurance, HMO, Medicaid, Medicare and private pay. The Billing Specialist may also function as an intermediary between healthcare providers, clients, patients and health insurance companies.

Supervisory Responsibilities: None

Major Responsibilities/Tasks:
  • Processes and reviews insurance claims, EOB, and vouchers for denials; posts payments; works account for collections; verifies reports; provides information to patients and insurance carriers, and prepares refunds.
  • Review denials or partially paid claims and work with the involved parties to resolve the discrepancy. Gathers information on each claim through a medical records review, notes, invoices, etc., and prepares appeals summaries while ensuring compliance with organization standards and the regulatory requirements.
  • Review electronic claims to ensure timely payment, adjust electronic claims in response to error messages, timely follow-up; send additional information as requested.
  • Responsible for processing charges, including the release of order entry, using correct CPT and ICD-9 codes, and being knowledgeable of current coding rules and regulations.
  • Provides support related to coding and billing issues to maintain compliance with policies, procedures, laws, and government regulations.
  • Communicate with health care providers, patients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.
  • Consult supervisor, team members, and appropriate resources to solve billing and collection questions and issues
  • Maintain work operations and quality by following standards, policies, and procedures; escalate compliance issues to supervisor.
  • Perform a variety of administrative duties including but not limited to: answering phones; faxing and filing confidential documents; and basic Internet and email utilization.
  • Maintain current and accurate computer data including documentation of all account activity
  • Review and understand correspondence received from third-party payers Adhere to all established performance goals and account for any performance variances
  • Prepare and submit reports in regards to billing and accounts receivable, as required
  • Maintain compliance with all state, federal, and government agencies
  • Operate billing software system for billing, Medicare system, and Medicaid billing system, and submit claims on payer websites as needed
  • Monitor/reconcile aging reports and take necessary steps to guarantee timely payment of claims
  • Attend and participate in meetings/seminars/in-services training as needed
  • Work effectively within the role independently and with other team members
  • Other duties, as assigned

KMHS is an equal opportunity employer that does not discriminate against people regardless of age, genetic information, national origin, race/color, ethnicity, gender identity, sexual orientation, neurodiversity, disability, or veteran status. KMHS envisions an anti-racist, equitable, inclusive, and collaborative community in which all can feel welcome.

Benefits:
  • Comprehensive and generous health, dental and vision benefits
  • Up to 19 days of PTO and 8 paid holidays your first year (pro-rated for part-time)
  • An incredible team approach that is dynamic and collaborative
  • Loan Forgiveness, training, and extensive education available
  • Multiple locations and opportunities close to home
  • Advancement opportunities available within the agency
  • Free Employee Assistance Program and parking
  • Full Time, Part Time and PRN positions along with flexible hours for professional advancement


Qualifications

Minimum Qualifications :

EDUCATION: High School Diploma or GED

EXPERIENCE: Entry Level (no experience required)

Preferred Qualifications:

EDUCATION: Bachelors Degree in Accounting, Business or a related field.

EXPERIENCE: Experienced (minimum 2 years of job-related experience)

Course work in medical/psychiatric terminology. Two or more years of working in the Billing, Front Desk or Patient Services fields

Experience using an Electronic Health Record (EHR).

T rained and active or working to achieve Certified Professional Coder (CPC) license.