Insurance Billing Specialist-Remote

ESSENTIAL FUNCTIONS AND BASIC DUTIES:

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

• N/A

Position-Specific Performance Expectations, Duties, and Responsibilities:

• Process and submit health insurance claims to various insurance companies in a timely and accurate manner.
• Ensure claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS). Collaborate with the coding and clinical departments to resolve edits and denials.
• Maintain a working knowledge of Medicare and Medicaid as well as commercial payer guidelines, and stay abreast of new policy changes.
• Verify patient eligibility and coverage details before claim submission, and reconcile coverage denials when necessary.
• Resolve claim edits both in the electronic medical record and in the clearinghouse to prevent denials.
• Follow up with insurance companies regarding denied or underpaid claims, and submit appeals when appropriate.
• Review insurance and patient credit balances and resolve them timely.
• Educate patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities.
• Document all actions taken with an account in the electronic medical record (EMR).
• Performs other duties as assigned.

 

Organization-Specific Performance Expectations, Duties, and Responsibilities:

• Demonstrates 100% commitment to performance in accordance with the CHOICE values of MRH and representing the organization in a positive and professional manner.
• Establishes and maintains effective verbal and written communication and good working relationships with all patients, staff, and vendors.
• Adheres to MRH attire/dress code per policies and procedures.
• Utilizes initiative; strives to maintain a steady level of productivity; self-motivated; and manages activity and time.
• Completes annual education, training, in-service, and licensure/certification requirements; and attends departmental and organizational staff meetings or reads meeting minutes.
• Maintains patient confidentiality at all times.
• Reports to work on time as scheduled; completes work within designated timeframes.
• • Actively participates in departmental and organizational performance improvement and continuous quality improvement activities.
  • Strives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state, and federal regulations and policies.
  • Follows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, the public, and staff.

             

  QUALIFICATIONS:

  Minimum Requirements:

  • Must be at least 16 years of age (21 for driving positions with a valid driver’s license).
  • Must be able to legally work in the United States.
  • Must be able to pass a background check.
  • Must be able to pass a drug screen and breath alcohol test (if applicable).
  • Must complete employee health meeting.

   

  Required Education/Licensure/Certification:

  • Medical billing or coding certification highly desired (CPC, CPB, RHIT, CCS, etc.).
  • High School Diploma or equivalent, preferred.

  Experience:                                                                         

  • Two (2) years prior experience in medical billing, accounts receivable, or related field required (can substitute with a medical billing or coding certification (CPC, CPB, RHIT, CCS, etc.).
  • Knowledge of UB-04 and CMS-1500 claim forms, preferred.
  • Epic or similar EMR experience, preferred.
  • Prior authorization process experience, preferred.
  • Typing speed of a minimum of 30 WPM, preferred.
  • Proficiency in Excel, preferred.

   

   

  Position Classification:  Non-Exempt

  Compensation Range: $24.99 TO $37.49

  Benefits:  Medical, Dental, Life, Retirement, Paid Time Off