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Medical Billing & Collection Specialist

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Indian Trail, NC, United States
Job ID: 27884
Job Family: Clerical Support
Status: Full Time
Shift: Day
Job Type: Regular
Department Name: 16041050936002-Ambulatory Services


Job Summary

Utilizes management reports, work queues, spreadsheets, payer remits, denials information to improve the claims submittal processes within the Surgery Center and reduce financial losses to the organization. Determine best case claim outcomes and can transmit issues upstream to Administration as needed to prevent recurrence of problems throughout the Surgery Center. Responsible for the daily billing, follow up and collection resolution of hospital and professional claims filed to various payors.

Essential Functions

  • Review medical records for documentation accuracy and assign the correct CPT and ICD-10 codes to the claim. May conduct or assign audit reviews of coding and procedures specification.
  • Performs and oversees all billing processes, including primary/secondary and rebilling, including necessary claim edits on both internal and external software systems.
  • Remains knowledgeable and current on rules and regulations related to all government payers: Medicare, Medicaid, VA, etc.
  • Checks clearinghouse transmission daily to ensure files are successfully transmitted to the intermediary. Works closely with vendors when problems or trends arise that impede work flow.
  • Handles follow up on billed patient accounts to successfully collect owed balances. Posts payments as required via cash, credit cards, EFT and third-party vendors, etc.
  • Reviews and adjudicates EOBs/RAs to determine if the Surgery Center was paid correctly by the payer.
  • Deals with denials in an efficient and effective manner, handling appeals as needed to get claims paid.
  • Remains actively involved in KPIs associated with the financial performance of the Surgery Center.

Physical Requirements

The ability to lift, carry or push/pull up to 20 pounds and, occasionally, lift carry, push/pull over 20 pounds. Standing, walking 30% of the time, and sitting 70% of the time. Eye/hand coordination, finger dexterity, color perception, functional visual ability and depth perception, functional sound perception and discrimination, functional verbal speech ability. Occasional bending, kneeling, climbing, twisting, reach at/or above and below shoulder level. Routine balancing as it pertains to normal office environment duties.

Education, Experience and Certifications

High school diploma required. An Associate degree, suitable Trade School or Coding Certification preferred. 2-5 years’ experience in a medical environment required, with strong medical terminology knowledge, preferably in the surgical realm. Thorough working knowledge of CPT and ICD-10 codes and can process outgoing claims, write billing edits, transmit transaction files and process payments. Strong typing skills, significant computer experience, email, copier and Microsoft office experience required. EMR experience required. EMR experience can be from a physician practice but should include both clerical and clinical functions. Knowledge of ASC billing preferred. Knowledge of billing rules and regulations through various governmental programs is required, as well as pertinent knowledge related to commercial claim submission and a firm grasp of all HIPAA guidelines.