Description:
The Medical Billing Specialist is responsible for managing the entire medical billing and claims process for Techilab's healthcare clients. This role is critical in ensuring accurate and timely reimbursement from insurance providers, as well as maintaining positive relationships with patients regarding their financial responsibilities.
Key Duties and Responsibilities:
Billing and Claims Processing
- Review patient charts and medical records to extract relevant billing information such as diagnoses, procedures performed, and supplies used
- Code medical services and procedures accurately using CPT, HCPCS, and ICD-10 coding systems
- Submit insurance claims electronically or by mail, following all payer-specific guidelines and requirements
- Follow up on unpaid or denied claims, appealing decisions and resubmitting as needed
- Process patient payments, generate invoices, and maintain detailed records of all transactions
Insurance Verification and Authorization
- Verify patient insurance coverage, benefits, and eligibility prior to services being rendered
- Obtain necessary prior authorizations from insurance providers for certain medical procedures
- Communicate with insurance companies to resolve coverage issues and ensure proper reimbursement
Revenue Cycle Management
- Monitor accounts receivable and generate reports on claims status, denials, and collection efforts
- Identify trends in denied claims and implement process improvements to reduce rejections
- Collaborate with the billing manager to develop strategies for maximizing reimbursement
Patient Accounts and Collections
- Field inquiries from patients regarding their medical bills, payment plans, and financial assistance
- Work with patients to set up payment arrangements and resolve outstanding balances
- Refer delinquent accounts to collections agencies when necessary, while maintaining compliance
Compliance and Continuing Education
- Stay up-to-date on changes in medical coding, billing regulations, and insurance policies
- Attend training sessions and complete continuing education courses as required
- Ensure all medical billing practices adhere to HIPAA and other relevant healthcare laws
Qualifications and Skills:
- Associate's degree or certificate in medical billing and coding, or equivalent work experience
- 2+ years of proven experience as a medical biller or in a similar healthcare revenue cycle role
- Thorough understanding of medical terminology, anatomy, and common medical procedures
- Proficiency in using medical billing software, electronic health record (EHR) systems, and Microsoft Office suite
- Strong problem-solving, analytical, and communication skills to work effectively with patients, providers, and payers
- Excellent attention to detail and ability to multitask in a fast-paced environment
- Commitment to ongoing professional development and maintaining certifications (e.g. CPC, CMRS)