Medical Billing Specialist reviews and verifies medical bills and invoices with accounts receivable ledger and patients. Ensures record accuracy, follows up, and makes necessary revisions. Being a Medical Billing Specialist processes changes in information system to support accurate and efficient billing process and financial close. Follows proper medical and insurance claim processes. Additionally, Medical Billing Specialist typically requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Medical Billing Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Medical Billing Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
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Summary:
This position is critical to the success of the revenue cycle process; in conjunction with clinical and non-clinical staff, the Billing Manager will contribute to all issues related to billing functions. This position will work with the Billing department, Finance, Operations, Information Technology departments and other pertinent staff on revenue cycle performance to meet short term and strategic goals.
Essential Functions:
· Directs all aspects of billing. Is responsible for monitoring an efficient and effective billing cycle designed to maximize revenues while adhering to compliance policies and procedures.
· Patient Accounting process alignment.
· Oversight of backlog, denials, and collections.
· Up-to-date training for coders and billers.
· Remain current with Medicare and Medicaid regulations for billable and non-billable services.
· Reviews and monitors month end reports including collections, AR, denials, and backlogs and monitors the month end revenue closely.
· Responsible to enroll in all insurance contracts are maintained.
Focus on Oversight and Leadership
· Work closely with the Finance department for revenue enhancement activities.
· Communicates regularly with Chief Financial Officer on departmental activities and issues; and informed on specific payer issues affecting reimbursement.
· Oversee the processing of all super-bills for all departments including ICD 10, CPT, HCPCS codes to adhere to individual contract specifications.
· Reviews and evaluate data entry of charges, credits, debits and payments monthly and report findings and recommendations to the Chief Financial Officer.
· Mentor, coaches, and counsels staff to develop excellent contribution to the corporation mission and assist in understanding the individual's role in the strategic plan. Fully documents staff issues.
· Reviews filing and terms of all commercial payors with Finance team to determine the appropriate contracted UCR fees.
· Maintains full compliance with the laws, regulations, grant terms, and policies pertinent to the department.
· Ensures department activities meet all applicable accrediting body standards and CMS Conditions of Participation.
· Actively avoids fraud, waste, and abuse. Seeks methods and activities to enhance revenues.
· Ensures sufficient internal controls to maintain integrity of all data processing activities and regular monitoring of third-party reimbursement changes, denials and appeals, unbilled revenue, and credit balance issues.
· Ensures that proper paperwork and approvals are maintained on administrative adjustment approvals, deposit waivers, uncompensated care approvals, bad debt
write-off approvals, refunds, denials, appeals, and certifications.
Required Education and Experience:
Education -
· High School Diploma or GED required.
· Must have a minimum of ten (10) years of work experience in healthcare billing with supervisory responsibilities.
· Must have knowledge of computerized billing, medical terminology, and ICD-10/CPT Coding.
If interested please apply or send reume directy to Hailey Flurnoy at or phone 559-500-6386
All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
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