Medical Billing Specialist

ADG Pathology; Houston (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

ADG Pathology seeks a Medical Billing Specialist to process insurance claims and invoices for pathology procedures in-office in Houston, TX. You will collect payments, post transactions, and resolve billing issues to optimize revenue for the company, clients, and patients.

Responsibilities include following the Revenue Cycle workflow, verifying patient demographics, eligibility, and COB, scrubbing claims, posting payments, and addressing denials.

Qualifications

• High School Diploma or GED required or equivalent.
• Certificate in healthcare billing preferred.
• Two years in billing/coding experience within the last five years.
• Accurate 10-key ability.
• Knowledge of EOBs, CPT & ICD-10 codes, HCFA, CMS-1500, HCPCS.
• Experience researching denials and resolving payments.
• Knowledge of government and commercial insurance billing, appeals, and prior authorization.

Responsibilities

• Follow the Revenue Cycle workflow.
• Ensure accurate patient demographics are captured in the billing software and communicate discrepancies.
• Verify eligibility and coordination of benefits; update as necessary for clean claim submission.
• Scrub new claims and resubmissions for accuracy in coding based on payer, rendering provider and billing group.
• Post payments and adjustments from payers.
• Handle assigned and unassigned denials promptly.
• Follow up on unpaid claims by contacting payers or using provider portals.
• Identify denial trends and communicate issues to management.
• Research and resolve issues to assure payment.
• Follow up on all paper and electronic correspondence from payers and patients.
• Interact with insurance companies, clients and patients to support the payment process.

Skills

Billing experience

Attention to detail

Accurate 10-key

Education

High School Diploma or GED

Certificate in healthcare billing

Tools

Billing software

CPT & ICD-10 knowledge

CMS-1500 familiarity

HCFA/HCFAs knowledge

Job description

The Medical Billing Specialist Accurately process insurance claims, invoices patient and client billing for pathology procedures. Collect payments from multiple sources, post and document all transactions. Manage issues and problems effectively for the best outcome for the company, our clients and patients.

This is a fully in-office position.

Key Job Functions

1. Follow the Revenue Cycle workflow
2. Ensure accurate and complete patient demographics are captured in the billing software. Communicate updates to administrative staff when discrepancies occur.
3. Verifying eligibility and coordination of benefits. Making updates as necessary for clean claim submission.
4. Scrub all new claims and resubmissions for accuracy in coding based on payer, rendering provider and billing group.
5. Post payments and adjustments received from payers
6. Work assigned and unassigned denials in a timely manner.
7. Follow up on all unpaid claims by contacting the payer or utilizing online provider portals.
8. Identify trends in denials, payment and non-payment and communicate issues to management and team.
9. Research, document and resolve issues to assure payment.
10. Follow up on all paper and electronic correspondence from payers and patients.
11. Interact with insurance companies, clients and patients to support the payment process.

Qualifications:

• High School Diploma or GED required. Certificate in healthcare billing preferred
• Two years in billing/coding experience within the last five years
• Accurate 10-key ability
• Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, CMS1500, HCPCS
• Experience in researching denials and how to resolve for payment
• Knowledge of government and commercial insurance billing, appeals, and prior authorization