Position Summary: The Billing Specialist is responsible for managing insurance follow-up and collections, including making calls and accessing payer websites to ensure successful claim submissions and reimbursements.
Essential Functions: To perform this role successfully, an individual must fulfill each essential function satisfactorily, with or without reasonable accommodations:
Process insurance billing both electronically and manually, using all available technology to ensure clean claims.
Interpret claims processing reports to enhance billing accuracy.
Keep updated on regulatory billing requirements and apply them effectively.
Update demographic information as needed to facilitate accurate claim production.
Post patient payments and follow up on unpaid accounts.
Issue patient refunds when necessary.
Meet or exceed productivity standards in completing daily tasks with accuracy.
Analyze coding to ensure claims are billed correctly; manage claims follow-up, denial posting, and appeals.
Attach necessary clinical documentation as per payer requirements.
Prioritize work to ensure timely account servicing, with knowledge of insurance and CMS regulations.
Post and interpret EOBs, resubmitting or appealing underpaid or denied claims.
Assign CPT/ICD-9/10 and HCPCS codes based on surgical/progress notes.
Handle inquiries from patients and insurance companies.
Demonstrate attention to detail, problem-solving abilities, and effective documentation of outcomes.
Maintain regular, reliable attendance.
Perform other duties as assigned.
Additional Information: Customer Focus: Primarily serves external customers (clients, centers of influence, vendors, community leaders).
Knowledge, Skills, and Abilities:
Education:
High school diploma or equivalent.
Experience:
0-3 years of experience in a dermatology practice or physician’s office setting handling billing for major insurance providers, third-party payors, and self-pay accounts.
At least 1 year of electronic billing experience.
Certifications and Licenses:
Medical Billing and Coding Certificate or Diploma
Technology Applications:
1 year of electronic billing experience (GE Centricity preferred)
Proficient in Microsoft Office applications.
Role-Specific Knowledge:
Medical terminology
HIPAA privacy laws
Physical and Mental Demands: Reasonable accommodations may be made for individuals with disabilities to perform essential job functions. The employee may occasionally need to stand, walk, sit for long periods, use hands, reach, climb stairs, balance, bend, or kneel. Must be able to lift, push, pull, and move up to 20 pounds. Vision requirements include close, distance, and peripheral vision, color vision, and depth perception.
Work Environment and Travel Requirements: The role is based in a well-lit, ventilated, and climate-controlled office with standard office equipment, some with moving mechanical parts.
