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MEDICAL BILLING SPECIALIST SUMMARY:

Performs all aspects of medical billing, including registration process and procedures, charge entry, payment entry, account modifications and follow-up.


ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Understands Connect data systems and technology.
  • Supports electronic submission and resubmission.
  • Performs claims processing, claims edit and charge correction.
  • Performs the receipt, storage and distribution of mail including EOB, payment, charge tickets, and supporting case information.
  • Coordinates data requirements with the client, payer, support, and QA.
  • Performs charge entry, registration, scheduling, and insurance verification.
  • Collects charge tickets and supporting case information and enters the procedure and case information into Connect.
  • Follows charge entry and registration processes and procedures.
  • Updates provider information and payers.
  • Receives and conducts phone calls with the patient, payer, and practice.
  • Collects patients demographics and patient account information.
  • Maintains a current understanding of insurance types and products.
  • Interprets statements to patients.
  • Responsible for account follow up activities including posting of payments, conducting collections and reconciliation activities related to the account.
  • Follows up on current and past due accounts.
  • Performs payment adjustments and receives approval for the payment adjustment.
  • Completes payment reversals and receives approval for the reversals.
  • Completes guarantor collection phone calls (insured, self pay).
  • Completes insurance collection phone calls (auto accident, Medicare, Medicaid, workers’ compensation, commercials).
  • Prints and balances receipt summaries.
  • Receives phone calls and correspondence from patients and payers related to payments.
  • Performs other activities and responsibilities as assigned.
  • Follows Company and Department policies and procedures, as set out by Company management.
  • Completes job duties and assignments timely, accurately and with a professional attitude and appearance.
  • Maintains a positive and cooperative relationship with other Company personnel.
  • Maintains a regular, predictable attendance, and has the ability to keep a regular work schedule.

POSITION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Education and/or Experience—

High school diploma or general education degree (GED) and three (3) years of related experience and/or training; or equivalent combination of education and training.


Skills and Other Capabilities—

  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
  • Ability to write reports, business correspondence, and procedure manuals.
  • Ability to effectively present information and respond to questions from staff, clients, supervisors and managers.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
  • Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Possess the organizational skills to manage and prioritize a multi-task position.
  • Possess interpersonal skills necessary to successfully interact with clients and Company staff.
  • Must maintain telephone and personal etiquette to effectively deal with clients, vendors, peers and management even under stressful conditions.
  • Must develop an excellent understanding of the organizations proprietary software and integrated third-party software.
  • Must be familiar with Microsoft® Excel, Word and Outlook.

If you would like to apply for this position, please e-mail your resume and cover letter to careers@ppmconnect.com.