Medical Billing Specialist
Job Description
Job Description
Searching for 1-2 billing specialists that would ideally have 1-3 years experience in billing to perform the following duties:
POSITION SUMMARY:
The Medical Billing Specialist is responsible for accurate and timely billing for orthopedic services, ensuring timely follow up and compliance with payer guidelines with the goal of maximizing reimbursement. This role requires strong knowledge of orthopedic procedures, familiarity with insurance websites, procedure coding including use of modifiers, and insurance regulations.
RESPONSIBILITIES:
EPIC experience required
Review Explanations of Reimbursement, determine basis for nonpayment, and compose an appeal in writing or utilizing the insurance website whichever is the preferred method by the respective insurance carrier.
Verify proper use of diagnosis codes, procedure codes, and modifiers.
Review operative reports to confirm coding accuracy and appeal denials for maximum reimbursement.
Resolve billing issues including denials and omissions and submit requests for review in a timely manner and within the guidelines of the individual insurance carriers.
Monitor the accounts receivable to keep current.
REQUIRED SKILLS
Great communications skills interacting with staff and insurance customer service representatives.
Knowledge of prior authorization and referral requirements.
Understanding of NCCI edits and bundling rules.
Ability to analyze denial trends and improve reimbursement processes.
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