Medical Billing Specialist
Job Description: Looking for a well rounded Medical Billing Specialist. Ideal candidate has minimum 2 years strong hands on application of ICD-10, CPT, and HCPCS coding systems and E&M Auditing and Chart
Auditing, as well as Medical Office Management background. Candidate must have the ability to work toward creating and maintaining good relationships with physicians, supervisors, co-workers, insurance carriers and patients. Additionally, ideal candidate will foster working as a team; dealing with and resolving conflict in a timely, efficient and positive manner and is willing to mentor and train non-billing staff about insurance and billing workflows pertinent to their particular job functions (i.e. front office, collections, eligibility, benefits and authorizations teams, etc).
Knowledge, Skills and Abilities:
1) Knowledge and strong hands on application of ICD-10, CPT and HCPCS coding systems
2) Knowledge and strong hands on application of chart review and documentation auditing
3) Knowledge of health insurance programs, coverage offered and third-party reimbursement mechanisms, including Medicare, Medi-Cal, PPO, HMO, IPA, PMG, Military and Veteran, Workers Compensation and their billing guidelines and processes
4) Knowledge of electronic medical record systems
5) Knowledge of manual and electronic billing systems andprocedures
6) Knowledge of eligibility, benefits and authorizations processes
7) Knowledge of general office procedures to create efficient and positive work environment
8) Knowledge of all health care services offered by each clinic site
9) Skill in communicating effectively to peers, supervisors and patients and to handle stressful situations appropriately
10) Skill in operating personal computer utilizing word processing, spreadsheets, databases, email and other office equipment
11) Maintains accurate and timely billing
12) Audits insurance information for appropriateness in current billing system and is able to quickly identify underpayments or other trends that may negatively affect cash flows
13) Ability to prioritize work and able to work with little or no supervision
14) Ability to communicate both verbally and written effectively and efficiently
15) Ability to maintain confidentiality of information, most importantly patient financial and medical information
16) Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
17) Follows timely filing guidelines per payer to ensure maximum payment
18) Ability to understand and respond appropriately, effectively, sensitively to special population groups as defined by race, ethnicity, language, age, sex, etc.
19) Ability to hear and speak well enough to converse over telephone
20) Ability to see well enough to use computer efficiently and read computer reports and correspondence
21) Strong Excel, Word and Power Point skills
22) Willingness to learn, understand and abide by company policies and procedures
1) Ensures billing of services meet standards set by medical corporation
2) Uses good judgment when auditing, preparing and billing charges to other entities for payment
3) Completion of daily, weekly and added special projects
1) Constantly alert for ways to improve customer service, improve patient flow, increase productivity, and improve utilization of resources communicating ideas to supervisor
2) Maintains infrequency of denials in the billing process
3) Ensures that electronic and hard copy claims are accurate and completed on time.
4) Verifies and ensures competency when utilizing EMR and Billing systems
5) Uses mathematical accuracy and attention to detail
6) Audits of invalid/rejected edits for accuracy in the electronic claims submission
7) Ensures provider correction requests are responded back to billing timely
8) Notifies supervisor of unusual occurrences and adheres to policy regarding incident forms and/or patient complaints
9) Attends and actively participates in staff meetings as requested
10) Attends and actively participates in staff training, webinars and seminars as requested
1) Positively supports requests from administrative office and supervisor in implementing policy and new programs
2) Dependable and punctual
1) Sets the example of exemplary patient and insurance customer service
2) Responds to patient or insurance representative calls in a professional manner
3) Reviews the terms of service performed, sliding fees, third party payments and payment collection with patient via telephone
4) Ensures cleanliness of work environment during operational hours and is always prepared to provide friendly assistance to patients, insurance and staff members
Lags Medical Centers is the primary care musculoskeletal provider for California's Ventura County, Central Coast, Central Valley, and now Portland, Oregon. Lags' commitment to total wellness and holistic healing is rooted in the use of non-invasive, ethical, and cost effective treatment plans that help patients manage and alleviate pain.
Lags has a 15 year record of working closely with community health centers, community healthcare providers and insurers to create meaningful relationships with patients and treatment plans that work.
Lags Medical Centers provide treatment options for patients that focus on total wellness. Our treatments are intended to be restorative, minimally invasive and avoid the expenses of long term medications.
In California's Ventura County, Central Coast and Central Valley, Lags works closely with county community health centers, as well as Concentra in Fresno. We have become the preferred provider in pain management for the regions' medi-Cal populations and now Lags is opening the first Oregon facility in Portland.
Role: Medical Billing Specialist
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