Job purpose

The Medical Billing Specialist assists with the reimbursement process by reviewing account information to ensure accuracy and completeness in order to generate and create compliant invoices.

Duties and responsibilities

• Complete all medical invoices by reviewing account data and entering billing software.
• Determines appropriate HCPCS codes, modifiers and other invoice specific requirements or special instructions as dictated by payer.
• Confirms all necessary documentation is on file including valid medical orders, Patient Agreement forms, evidence of patient use, and authorization as required by payer.
• Complete initial invoices as well as all subsequent and replacement invoices for the duration of patient use, confirming all data is entered completely and correctly into the billing software.
• Reviews Patient Agreement forms for completeness and compliance prior to invoice billing. Also responsible for acceptance or rejection of this form, communicating with external departments as needed to identify and correct errors.
• Requests invoice adjustments for various reasons based on but not limited to compliance and documentation.
• Contacts hospitals and other facilities to verify the patient has been discharged to the home prior to initial invoice completion as required by payer.
• Responsible for working all assigned account exceptions in order to confirm or obtain complete and correct information needed for invoice completion daily.
• Responsible for coding invoices appropriately for tracking purposes as instructed by invoice requestors.
• Responsible for meeting department standards in relation to production, quality, attendance and carryover as identified, tracked and reviewed on monthly scorecards.
• Responsible for adhering to all company processes and procedures as identified in employee handbook.

• Performs other duties as assigned by Management.

Qualifications

Qualifications include:

• H.S. Diploma or equivalent required.
• Minimum 1-2 years of experience in medical billing or certification in Medical Billing and Coding.
• Experience with Microsoft Excel, email programs and online information systems.

• Experience working with all payer types to include Medicare, Medicaid, and third-party commercial insurance companies.