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The Billing Specialist is responsible for verifying that insurance claims are properly submitted, and all services provided to clients are billed out to correct payers in a timely manner, following up on unpaid reimbursements. This process involves reviewing client records, maintaining date in clinical databases, and using EHR software to correctly assign procedural and diagnostic codes.

Submit claims for services for new or existing clients’ services provided for new or existing client in accordance with insurance and payor policies while following all federal, state, and local regulations including Medicare and Medicaid guidelines.
Provide mediation between WGA and clients and responsible personnel and sources of revenue, to ensure he appropriateness and accuracy of all changes as well as records of all client transactions.
Maintain all client accounts with the use of a billing system using codes meant to facilitate reimbursement from commercial and government insurance groups.
Collect necessary client data on diagnosis, treatment, eligibility, and insurance verification required for billing purposes.
Manage the status of client accounts and balances and identity inconsistencies; ability to review, update/correct erroneous billed changes or claims.
Resolve reimbursement problems with insurance companies (overpayments, duplicate payments, non-coordinated secondary payments, coding errors.)
Reconcile and rack incoming electronic payments and remittances receive, sort, and accurately apply all incoming payments with attention to credibility.
Monitor and work aged receivables reports, checking status of claims and appeals.
Work collaboratively with the administration team to collect prepare and record daily banks deposit.
Handle incoming business office phone call; respond to billing questions from clients. Administration/clinical teams and payors/insurance companies. Prepare letters and correspondence for accounts collection using appropriate spelling, punctuation, and grammar.
Attend and participate in staff meetings and trainings. Adhere to/maintain client confidentiality according to HIPAA and Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part 2) Knowledge of and compliance with WGA policies and procedures and other duties as required or assigned.

Qualifications:
• High School Diploma or GED and one to two years in secondary education such as a medical billing certificate program, OR associate degree, preferably in Finance, Accounting or Business.
• Minimum one year of relevant office experience that involves public contact in medical or health-related offices.
• Must have computer knowledge and experience in Windows-based programs, MA office; preferably some EHR experience.
• High degree of attention to detail and trustworthiness.
• Knowledge of health insurance billing/collections practices, including EOBs or remittances, insurance contractual adjustments, and allowable amounts.
• Ability to prioritize a variety of tasks, following through to completion.
• Demonstrate confidence in problem-solving and decision-making.
• Excellent interpersonal, customer service, telephone skills, and office etiquette.
• A self-starter with the ability to work accurately and efficiently under pressure with minimal supervision.
• Ability to interact effectively and in a supportive manner with people of all backgrounds.
• Must pass a pre-employment drug screen and TB test.

Reference : Billing Coding Specialist jobs

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Published at 28-05-2024
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