Medical Billing Specialist

POSITION PURPOSE:

This position is responsible for prompt, accurate, and effective medical insurance claim submission, with follow-up of claims to satisfactory resolution.

ESSENTIAL FUNCTIONS:

Review medical documentation and assess for proper coding utilizing CPT, HCPCS, and ICD10 coding materials, working closely with providers and other medical staff to ensure accuracy.

Submit clean claims to all payer types for prompt return of accounts receivable.

Follow-up on unpaid claims and resolve any billing issues in a timely manner.

Stay current on coding and billing guidelines for all payer types, to include commercial, government, and worker’s compensation.

Identify accounts which may require a refund and process appropriately.

Manage claims through various online tools and reporting systems.

Identify education needs for providers and medical staff based on coding assessments and/or updates, and act accordingly.

Assist patients with billing questions and issues, to include guidance on office policies regarding sliding scale discounts and payment arrangements for outstanding balances.

Post payments in practice management system, maintain batch controls and run reports appropriately.

Assist front office staff with billing questions relating to proper registration and scheduling of appointments as needed.

Participate in projects, trainings, and office/staff meetings.

Follow all Aviva Health policies and procedures.

QUALIFICATIONS:

High School Diploma or GED required.

Minimum of one year experience in medical billing utilizing ICD-10, CPT, and HCPCS coding.

Excellent written and oral communication skills.

Certification in medical coding/billing preferred.

WORKING CONDITIONS:

Must be able to perform the following physical requirements:

Remain in a stationary position frequently throughout the day while performing duties.

Move or traverse occasionally throughout the day throughout the worksite.

Operate equipment frequently throughout the day: computer, phone, printer, standard office equipment.

Ability to communicate information and ideas clearly and accurately so others will understand; ability to interact with patients and staff clearly.

Able to move or transport up to 5 pounds while transporting laptop computer.

Work on-site indoors in heat-controlled environment frequently throughout the day.

OSHA Exposure Category – Category #2: The normal work routine involves no exposure to blood, body fluids, or tissues.

Onsite work in office.

Normal business hours.

If employee becomes eligible to work remotely, periodic travel to the office for work is required and a remote work agreement and regular home office safety inspections are required.

DISCLAIMER:

Employees must be able to perform the essential functions of their position satisfactorily. Aviva Health will make reasonable efforts to accommodate a qualified applicant or employee with a known disability unless such accommodation creates an undue hardship on the operation of the business. To request a reasonable accommodation, please contact the VP of Human Resources or their designee by email.