Billing Specialist

Healthcare Outcomes Performance Co. (HOPCo); Phoenix (AZ); On-site; USD 40,000 - 55,000; Full time

Job summary

Healthcare Outcomes Performance Co. (HOPCo) is seeking a medical billing specialist in Phoenix, Arizona. This position requires maintaining productivity and accuracy metrics, resolving claim errors, and managing patient and insurance information.

The ideal candidate will have at least two years of experience in medical billing, knowledge of ICD-10, HCPS, and CPT codes, and advanced computer skills. The role offers the opportunity to work in a dynamic team focused on efficiency and accuracy in claims processing.

Qualifications

• Minimum two to three years of experience in medical billing.
• Prior experience working claim errors in a claims management system is preferred.
• Understanding of revenue cycle vendor-supplied software is an advantage.

Responsibilities

• Maintain productivity and accuracy metrics.
• Resolve claim errors in the claims management system.
• Review insurance rejections and determine appropriate action.
• Correct billing errors and resubmit claims.
• Verify patient demographic information and insurance eligibility.
• Communicate trends to management.
• Maintain payer website user access.
• Manage system maintenance of master files.
• Handle EDI, ERA, and EFT enrollments for payers.

Skills

Medical billing experience

Knowledge of ICD-10, HCPS, and CPT codes

Advanced computer skills

Experience with claims management systems

Knowledge of revenue cycle applications

Education

High school diploma or GED

Job description

Responsibilities

• Maintains productivity and accuracy metrics per department expectations.
• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Assist in identifying and communicating trends and/or potential issues to management team.
• Payer website user access maintenance.
• Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
• Responsible for EDI, ERA and EFT enrollments for all payers.

Education

• High school diploma or GED

Experience

• Minimum two to three years of experience in medical billing. Experienced candidates will have prior experience working claim errors in a claims management system. Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.

Requirements

• Requires demonstrated knowledge of revenue cycle applications. Prefer prior experience configuring revenue cycle vendor-supplied software.

Knowledge

• Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
• Advanced computer knowledge, including Window based programs.