Billing Specialist

Essential Duties and Responsibilities :

 Obtain referrals and pre / post-authorizations for ambulance services

 Check eligibility and benefits verification

 Review insurance and facility claims for accuracy and completeness

 Prepare, review, and transmit claims using billing software, clearinghouse, and payer websites

 Following up on unpaid claims within standard billing cycle timeframe

 Reviewing underpaid claims for appropriate escalation steps to ensure appropriate reimbursement for services

 Calling insurance companies regarding any payment discrepancies

 Identifying and billing secondary or tertiary insurance

 Processing incoming mail and taking appropriate follow up actions to resolve accounts

 Researching and appealing denied claims

 Answering all patient or insurance telephone inquiries

 Contacting the patient to escalate issues with the insurance companies

 Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

 Performing other duties as assigned.

Qualifications :

 Proficient with a PC

 Knowledge of Health Insurance Portability and Accountability Act (HIPAA)

 Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes)

 Knowledge of medical terminology

 Knowledge of Medical Billing

 Knowledge of insurance guidelines including HMO / PPO, Medicare, Medicaid, and commercial payers

 Customer service skills for interacting with patients regarding medical claims and payments, including

communicating with patients and family members of diverse ages and backgrounds.

 Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections

 Ability to work independently and with a group

 Working knowledge of MS Word, Excel

 Ability to maintain effective working relationships.

 Thorough knowledge of office practices

 Ability to type at least 35 words per minute.

 Proficiency using 10 key

Education and Experience Requirements :

 High School Diploma or GED

 Minimum of one year revenue cycle management experience or related experience

Physical Requirements :

 Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other

federal, state and local standards, including meeting qualitative and / or quantitative productivity standards.

 Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local

standards.

 The employee may occasionally be required to lift and / or move up to 20 pounds

 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision,

depth perception, and the ability to adjust focus.

 Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and

other physical exertion.

 Must be able to talk, listen and speak clearly on telephone.

 Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a

motor vehicle.

Travel Time : Negligible