The PediaPlex Medical Billing Specialist has many duties that must be completed from day to day, most of them involving the recording and negotiating of client bills. The Medical Billing Specialist works very closely with the Client Billing Manager to complete tasks.
- High School education or equivalent required
- An Associate’s degree from a community college or technical school preferred
- Must be organized, efficient with numbers, and able to speak with customers who may be under stress due to unpaid debts
- Must be able to make collection calls to clients who have an outstanding balance
- Knowledge of specific medical terminology, as well as knowledge of CPT and ICD-10 codes
- Must be friendly but assertive
- Must be highly confidential with patient information
- Proficient in Microsoft Excel, Word, PowerPoint, Outlook
- Accounting and reconciliation experience required
- Three years’ experience in healthcare billing or insurance billing
- Medical billing and collections experience preferred
MAJOR RESPONSIBILITIES AND DUTIES:
- Invoice appropriate treatments in practice management software
- EOB review and reconciliation
- Work with health insurance companies to correct claims.
- Contact clients for payment discrepancies.
- Run batch patient invoices
- Process inactive files making sure balances have been paid in full.
- Review billing codes assigned to treatment.
- Verify benefits with health insurance companies for new and existing patients
- Prepares and submits clean claims to various insurance companies either electronically or by paper.
- Fax necessary paperwork to insurance companies as requested to ensure payment on claims.
- Answers questions from patients, clerical staff and insurance companies.
- Identifies and resolves patient billing complaints.
- Prepare, review and mail patient statements.
- Create insurance forms for each new clients
- Complete clinical submissions and pre-determinations for clients
- Maintain clients visits limits and request authorizations as needed
- Follows and reports status of delinquent accounts.
- Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
- Participates in educational activities and attends monthly staff meetings.
- Conducts self in accordance with PediaPlex’s employee manual.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Clinic Support & Work Conditions
- Use effective verbal and written communication skills.
- Complete all trainings and professional development requested in a timely manner.
- Demonstrate the ability to handle multiple tasks effectively.
- Demonstrate the ability to work under timeline demands.
- Demonstrate the ability to assist in all areas of the clinic as requested.
- Demonstrate the ability to self-initiate tasks and projects that will benefit clients as well as the staff and clinic.
- Complete Community Support Events in order to participate in community outreach events that benefit our clients, help educate the general public and connect the general public to services.
- Complete all other duties and responsibilities as assigned.
Physical Effort & Work Environment
- Physical, mental, and emotional stamina to perform the duties and responsibilities of the position.
- Mental acuity to collect and interpret data, evaluate, reason, define problems, establish facts, draw valid conclusions, make valid judgments and decisions.
- Physical agility to sit, stand, kneel, walk, push/pull, squat, twist, turn, bend, stoop and to reach overhead.
- Physical stamina sufficient to sustain light physical labor for up to 8 hours, sit and/or walk for prolonged periods of time.
- Physical mobility sufficient to move about the work environment for sustained periods of time on hard flooring, climb slopes, stairs, ramps and to respond to emergency situations.