Billing Specialist

Hempstead County; Pagedangan; On-site; IDR 725,689,000 - 1,179,245,000; Full time

Job summary

Pafford Emergency Medical Services is looking for a Billing Specialist to manage referrals and pre/post-authorizations, verify eligibility, and submit ambulance service claims. This role requires attention to detail and knowledge of medical billing processes.

You will review claims for accuracy, follow up on unpaid or denied claims, and maintain HIPAA compliance while communicating with patients and payers. High school diploma or GED and revenue cycle experience are preferred.

Qualifications

• Proficient with a PC and standard office software.
• Knowledge of HIPAA and patient privacy requirements.
• Knowledge of HCPCS and ICD-10 coding.
• Familiarity with medical terminology and billing terminology.
• Understanding of insurance guidelines including HMOs, PPOs, Medicare and Medicaid.
• Strong customer service skills for interacting with patients and payers.

Responsibilities

• Obtain referrals and pre/post-authorizations for ambulance services.
• Check eligibility and benefits verification.
• Review claims for accuracy and completeness.
• Prepare, review, and transmit claims using billing software and payer websites.
• Follow up on unpaid claims within standard billing cycle timeframe.

Skills

HIPAA knowledge

HCPCS ICD-10 codes

Medical terminology

Revenue cycle knowledge

Customer service

Problem solving

Independent work

Communication

Office practices

Education

High School Diploma or GED

Tools

MS Word

Excel

Billing software

Clearinghouse

Payer websites

10-key

Job description

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 escalat 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

NOTE:

The above statements are intended to describe the general nature and level of work being performed by the person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills and physical demands required of personnel so classified.