Billing Specialist - Orthopedics
This position is responsible for preparing accurate and compliant claims to be billed to Medicare, Medicaid and other insurance companies either electronic or paper and correcting any claim errors prior to claims submission and must also ensure that claims billed do not exceed the timely filing limits and re-submit any claim as necessary.
- High School Diploma/GED is preferred
- Two (2) years billing experience in an MD office or hospital setting preferred
- Basic computer skills and the ability to use Excel and Microsoft office products are required
- Knowledge of healthcare reimbursement is required
- Good written and verbal communication skills are required.
- Ability to read, write and speak English
- Ability to communicate clearly and concisely with all levels of Management
JOB KNOWLEDGE, SKILLS, AND EXPERIENCE:
- Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
- Establishes and maintains long-term customer relationships, building rapport with other department staff
- Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM.
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
- Requires reasoning ability, good independent judgment and working with frequent interruptions
- Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code, and Modifier knowledge is preferred
- Ability to use the internet to obtain information from Third Party Payers or other sources is required
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Demonstrates proficiency in billing and follow up of Medicare and Medicaid claims on-line or through billing software
- Ability to use the internet for TMHP access, and insurance verification sites.
- Submits adjusted claims to Medicare through online automated system.
- Daily, works all identified insurance edits through electronic billing system and work administrator.
- Transmits all information to the billing vendor daily for electronic claims filing
- References updated ICD-9-CM/ ICD-10-CM, CPT, Modifiers and HCPCS Level II code books/on line as needed
- Works and follows up on the work administrator report and resubmits the claims daily to billing vendor
- Works denied claims or appeals through the electronic billing system daily
- Mails paper claims to the insurance carriers as per requirement on a daily basis
- Works the accepted and rejected reports from the billing vendor and documents on patient management in the appropriate account
- Prepares the billing packets for billing vendor daily
- Communicates billing issues with the supervisor/manager immediately
- Responsible to send ticklers to Coding as needed for clarification on diagnosis, CPT , HCPCS, or Modifier
- Utilizes tickler, when requesting additional information from other co-workers or departments
- Ensures that all pertinent account activity is documented 100% by entering the documentation into the computer system notes
- Reads any updated, changes and corrections needed by the carrier
- Proficient in accessing information needed from Cerner and AX document imaging software to access medical records from Cerner system to appeal claims with carriers
- Request copies of medical records for any paper records
- Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures
- Other duties as assigned