Billing Specialist II

Clearway Pain Solutions; Annapolis (MD); Remote; USD 34,440,000 - 39,950,000; Full time

Benefits offered by this job

Health benefits

401(k) retirement plan

Paid time off

Short-term disability

Life/AD&D

Job summary

Clearway Pain Solutions is seeking a Billing Specialist to support the complete and timely revenue collection by accurately coding and entering patient data. The role tracks high-dollar claims from entry to payment and resolves complex payer issues, while following up on outstanding items.

The position is remote and open to candidates in MD, DE, VA, NJ, PA, FL, AL, GA, SC, and TX, requiring knowledge of CPT/ICD-10 coding and strong communication skills.

Qualifications

• High School Diploma or equivalent with a minimum of five years related experience.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Excellent written and oral communication skills, including customer service.
• Able to establish and maintain effective working relationships with doctors, staff and the public.
• Able to work independently or in a team and follow instructions.
• Must follow a flexible schedule and handle stressful situations.
• Must multi-task, prioritize and maintain attention to detail.
• Must know CPT and ICD-10 coding rules and third-party payer guidelines.
• Must have healthcare terminology knowledge and general healthcare experience.
• Commitment to professional conduct and continuous improvement.

Responsibilities

• Reviews and resolves payer denials, including appeals and coding corrections.
• Performs daily claim processing, status checks and re-bills.
• Responds to patient and staff billing inquiries.
• Maintains tracking logs for high-dollar procedures and reports to management.
• Coordinates with authorization department to resolve issues with complex procedures.
• Analyzes accounts receivable to keep DSO under 60 days.
• Navigates insurer portals to research policies and payments.
• Protects PHI and complies with HIPAA requirements.
• Produces and updates reports as directed.

Skills

Attention to detail

Microsoft Office

Excellent communication

Teamwork

Problem solving

HIPAA knowledge

Education

High School Diploma or equivalent with at least 5 years related experience

Tools

EMR system

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.
• 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.