Billing Specialist II

clearway; Annapolis (MD); Remote; USD 71,635,000 - 83,097,000; Full time

Benefits offered by this job

PTO up to 96 hours

7 Holidays

401(k) with employer match

Medical, Dental, Vision benefits

Short-Term Disability

Long-Term Disability

Life/AD&D

Employee Assistance Program

Voluntary Life

Accident

Critical Illness

Hospital Indemnity

Overtime pay (non-exempt)

Job summary

Clearway is seeking a Billing Specialist to support the complete and timely revenue collection by coding and entering patient and charge information into the billing system. The role tracks high-dollar claims from entry to payment and resolves complex carrier issues.

This remote position requires residence in operating states and involves follow-up on complex claims and denials. You will collaborate with the billing team to ensure accurate documentation, perform appeals, and maintain a

Qualifications

• High School Diploma or equivalent with 5+ years related experience.
• Proficient in Internet and Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Excellent written and oral communication and customer service.
• Ability to work with doctors, clinical staff and the public.
• Able to work independently and in a team.
• Follow verbal and written instructions.
• Flexible schedule availability.
• Patience under stressful patient health and emergent situations.
• Multi-tasking and prioritization skills.
• Attention to detail, strong organization, problem-solving and quality standards.
• HIPAA compliance knowledge.

Responsibilities

• Review and resolve payer denials, including appeals and coding corrections.
• Assist auditor in reviewing notes for medical necessity.
• Coordinate with authorization department to resolve complex procedures.
• Run and maintain tracking logs for high-dollar procedures and report results.
• Contact Provider Service Representatives to resolve recurring payment issues.
• Act as a resource for Billing Staff on complex issues.
• Analyze and resolve billing issues; keep A/R under 10% over 60 days.
• Process daily correspondence, claim status, denials, appeals and re-bills.
• Answer billing questions from patients and internal staff.
• Update patient files with changes to addresses and contacts.
• Review policy changes and inform supervisor and charge entry specialist.
• Navigate insurer websites to research policies and payments.
• Keep supervisor informed about accounts receivable matters.
• Respond to requests from billing company promptly.
• Research denials and submit correct claims/medical documentation.
• Review and manage claims within dashboard hold buckets for resolution.
• Create, maintain and update reports as directed.
• Maintain confidentiality per HIPAA rules and regulations.
• Assist in training new revenue cycle staff.
• Collect and review end-of-day reports.
• Check work e-mail regularly throughout the workday.
• Participate in required trainings and in-services.
• Perform other duties as assigned.

Skills

Excellent written and verbal comun c.

Customer service focus

Strong organizational skills

Attention to detail

Multi-tasking and prioritization

Problem solving and reasoning

Teamwork

Flexibility/work schedule

Professional appearance/attitude

HIPAA awareness

Education

High School Diploma or equivalent with 5+ years related experience

Tools

MS Word

MS Excel

MS PowerPoint

MS Outlook

Internet

Job description

The Billing Specialist supports the complete and timely collection of revenue for assigned groups by performing accurate coding and entry of patient and charge information into the billing system. This position will track all high dollar claims from charge entry to payment and will resolve complex carrier issues. The individual actively follows up on outstanding complex claims/or charges.

This is a remote position. Candidates must live in one of the states where we currently operate: MD, DE, VA, NJ, PA, FL, AL, GA, SC, and TX.

Essential Duties and Responsibilities:

• Reviews and resolves complex issues that result in payer denials, including appeals, coding corrections, medically necessity rules and other related functions.
• Assists the auditor in reviewing notes for medical necessity.
• Works with the authorization department to resolve authorization issues with complex procedures.
• Runs and maintains tracking logs to track complex high dollar procedures and report the results to the billing department management team.
• Contacts the various Provider Service Representatives to resolve repetitive payment issues
• Acts as a resource for the Billing Staff for complex issues.
• Analyzes and resolve billing issues, keeping A/R to no more than 10% over 60 days.
• Processes daily correspondence, claim status, handle denials, appeals and re-bills.
• Answers billing questions and inquiries from patients and internal staff.
• Updates patient files with address changes, contact information changes, etc., as needed.
• Reviews all policy changes on a regular basis and informs supervisor and charge entry specialist of such changes.
• Efficiently navigates assigned insurance companies' proprietary websites to find policies, research payments, etc.
• Keeps supervisor apprised of matters regarding accounts receivable.
• Responds to requests from billing company in a timely fashion.
• Researches denials and submits correct claims/medical documentation.
• Reviews and manages claims within the work dashboard hold buckets for resolution.
• Creates, maintains and updates reports, as directed.
• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
• Helps train new revenue cycle staff.
• Collects and reviews end of day reports.
• Checks work e-mail on a regular basis throughout the workday.
• Participates in and complete all required trainings and in-services.
• Performs other duties as assigned.

Minimum Qualifications:

• High School Diploma, or equivalent WITH a minimum of five (5) years related experience; OR an equivalent combination of education and/or experience.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Must have excellent written and oral communication skills, including exceptional customer service.
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
• Must be able to work individually as well as within a team.
• Must be able to follow both verbal and written instructions.
• Must be able to work a flexible schedule.
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
• Must be able to multi-task and prioritize.
• Must demonstrate extreme attention to detail.
• Must possess strong organization skills.
• Must be able to problem solve and use reasoning.
• Must be able to meet predefined quality standards.
• Must maintain and project a professional attitude and appearance at all time.
• Must have a working knowledge of CPT and ICD-10 coding rules.
• Must have a solid foundation of insurance knowledge and guidelines for third party payers.
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Two (2) years’ experience working with an Electronic Medical Record (EMR).
• Medical Billing Certification

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.

Compensation and Benefits:

• Pay Range: $25.00/hr - $29.00/hr
• PTO: Up to 96 hours in first year (pro-rated based on start date)
• Holidays: 7 (New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement: 401(k) with employer match
• Health Benefits: Medical (single and family), Dental (single and family), Vision (single and family)
• Other Company-Paid Benefits: Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
• Other Voluntary Benefits: Voluntary Life, Accident, Critical Illness, Hospital Indemnity
• Other Compensation: This position is non-exempt (hourly) and eligible for overtime pay in accordance with applicable law. Overtime is not guaranteed. This position is not eligible for bonus, commission, incentive, or shift differential pay.