MEDICAL BILLING SPECIALIST - CLINIC ADMINISTRATION

Hoag Memorial Hospital Presbyterian
 
Costa Mesa, CA
Experience & Skills
  • CPT coding
  • ICD-10
  • Medical coding
 
 
 
Job Summary:
The Billing Specialist processes, ensures accuracy, and compliance for healthcare professional medical claims. Maintains databases, audits information and works with patients to process patient payment.

 
The Specialist provides close communication between all parties to ensure all records are up-to date, compliant with regulations and consistent. The Specialist also answers billing inquiries, works out payment plans and employs timely follow-up collection methods to maintain revenues. The Specialist maintains confidentiality and is knowledgeable of ICD-10 codes, CPT codes, HCPCs and HIPPA.

 
Essential Functions
  • Works assigned accounts receivable according to department standards
  • Working knowledge of PPO, HMO and government payer guidelines.
  • Process healthcare professionals’ medical claims
  • Process patient payments and research and resolve patient billing problems and issues
  • Process patient data, communicate information with patients and staff
  • Work with patients to develop self-pay arrangements and pay plans
  • Work well with others, be a team player
  • Charge Entry/Claims Processor/Collections
  • Review each account to determine the best way to approach the patient for payment to maximize revenue using CPT coding.
  • Responsible for reviewing insurance denials and appealing when applicable
  • Responsible for reporting payer trends that directly impact cash flow
  • Responsible for incoming patient calls using established scripts, protocols and processes
  • Accurately tracks and enters calls using appropriate documentation
  • Reviews high level complaints and responds back within department standards
  • Responsible for updating practice management system with correct information in regards to insurance and patient registration
  • Responsible for creating payment plans and providing FAP information to patient
  • Develop collections methods that consistently lead to achieve or exceed company financial goals
  • Solve problems quickly and create resolutions that bring in revenue on a regular basis
  • Complete claims work list in all aspects for proper payment
  • Answer billing inquiries from patients and work each call to resolution
  • Maintain regular cooperation and compliance with all regulatory, accrediting and membership-based organizations
  • Maintain and update accurate databases with Insurance companies and maintain credentialing paperwork with the health plans
  • Close communication with all providers to ensure records are up-to-date and consistent
  • Claims work lists, working all aspects to complete status of payment
  • Efficiently credential all initial applicants in a timely fashion
  • Process applications and paperwork, checking for full completeness and accuracy
  • Research and resolve patient, providers and insurance companies concerns in a timely matter
  • Prepare and submit all appropriate applications and required supporting documentation
  • Follow-up with Insurance companies to insure timely processing of applications and contracts
  • Work well with others/Team Player, supports the development of other coders/billers
  • Process healthcare professional medical claims as needed
  • Work with Billing Specialists to resolve outstanding balances
  • Position may require local travel between various locations.
  • Perform other duties as assigned
 
  • Education, Training and Experience
Required:
  • Specialist I: 1 plus years’ in the medical field, High School diploma or higher, Computer knowledge Knowledge of EHR, Excel, Office, Word, knowledge of ICD-10 codes, CPT codes, HCPCs and HIPPA
  • Specialist II: 2 plus years’ in the medical field of billing and coding, High School diploma or higher, Computer knowledge, Knowledge of EHR, Excel, Office, Word, knowledge of ICD-10 codes, CPT codes, HCPCs and HIPPA
  • Specialist III: 4 years’ in the medical field of billing and coding High School diploma or higher, Computer knowledge, Knowledge of EHR, Excel, Office, Word, knowledge of ICD-10 codes, CPT codes, HCPCs and HIPPA
Preferred:
  • Certified coder is preferred. 1-2 years of experience with women's health, OBGYN

 
Skills or Other Qualifications
Required:
  • Specialist I:
    • Ability to maintain confidentiality
    • Ability to: Read/Interpret documents, Write reports/correspondence, speak clearly/concisely Language: English, Listen Effectively, and Interface with the Public
    • Ability to: Problem Solve, use Analytical and Reasoning, be Proactive, Flexibility/Adaptive to change, Ability to Multi-task, Work under Stressful Conditions, Independent Judgment, Mathematical, Business Acumen/Demeanor, Customer Service, Teamwork/Team Player, Organization Skills
  • Specialist II: In addition to the above level I abilities, the level II is expected to participate in training and development. Level II has a developed ability to problem solve and collect.
  • Specialist III: In addition to the above I, and II abilities, the level III is expected to share knowledge and participate in training and development. Level III has skill in process knowledge and computer skills, knowledge of HER, Excel, Office, Word, Specialized knowledge of ICD-10 codes, CPT codes, HIPPA guidelines and HCPC’s

License and Certifications
Required:
Preferred: Certified coder is preferred. 1-2 years of experience with oncology.