SUMMARY: Under the supervision of the Revenue Cycle Management Manager, the Medical Billing Specialist I performs high volume advanced data entry work. Work involves entering, verifying, researching, coding, correcting, or retrieving information from source documents and/or computer systems with a high level of accuracy. 

DUTIES AND RESPONSIBILITIES include but are not limited to:

• Prepare and submit claims, either electronically or by paper, to private health and County/State insurance companies. Contact insurance companies in order to correct billing issues and resubmit claims to third-party payers.
• Serve as medical billing point of contact for county representatives. 
• Review patient records daily for accuracy, supply any missing information, and ensure compliance with company policy and government regulations.
• Identify billing errors by interpreting transactions. Follow and report on the status of billing transactions.
• Develop, generate, and maintain up-to-date billing and revenue cycle reports within the database by tracking billings, monitoring collections, and analyzing financial data. 
• Ensure compliance with HIPAA regulations by following confidentiality protocols and being aware of accessibility to sensitive information.
• Access patient records as needed for review by physicians, technicians, and other medical staff members.
• Follow professional standards and meet requirements of local, state, and federal regulations.
• Other duties as assigned. 

EDUCATION and/or EXPERIENCE 

Possesses a high school diploma or equivalent. Medical Billing Certification and three (3) years of medical billing experience, preferably in behavioral health, or an acceptable equivalent combination of education and experience. 

To perform this job successfully, an individual must be able to perform each essential functions satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. 

• Working knowledge of insurance terminology (out-of-network benefit s vs. in-network benefits, as well as coinsurance, co-pays, and deductibles), in addition to demonstrating working knowledge of medical billing practices.
• Working knowledge of cash postings, billing, follow up, insurance registration, authorization management and claim denials.
• Working knowledge of Professional billing (CMS1500)
• Working knowledge and experience with EHR and billing software programs required.
• Possesses and demonstrates professional telephone demeanor and appearance.
• Demonstrates the ability to work in a fast-paced environment; can multi-task and work independently as well as with a team.
• Displays the ability to keyboard 30 wpm; is proficient in Word, Excel and Outlook.
• Must be willing to travel, when necessary. 

COMPUTER SKILLS – Demonstrate the ability to use a computer and applicable computer software effectively. Intermediate knowledge of Excel & Word, Adobe, PowerPoint, and Outlook. Experience with DocuSign and any other project management product software required.
 

LANGUAGE SKILLS and MATHEMATICAL SKILLS - Demonstrate the ability to read, comprehend, and respond appropriately through written or verbal form; demonstrate tactfulness when communicating including internal communication with staff members of all levels; ability to communicate with a variety of audiences effectively. Ability to add, subtract, multiply, and divide in all measure units, using whole numbers, common fractions, and decimals.

REASONING – Demonstrate the ability to effectively apply common sense and follow through to daily tasks; demonstrate the ability to work with little or no supervision; demonstrate excellent analytical skills; demonstrate the ability to efficiently conduct research and ask appropriate probing questions to complete necessary tasks.

PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit and stand; use phone and headset; use hands, arms, fingers to type; answer phones; write; use calculator; demonstrate strength to lift and carry materials weighing up to 10 pounds; demonstrate clear vision to read printed materials and a computer screen; hearing and speech to communicate in person and over the telephone; and drive a motor vehicle on public roads and highways.

SENSORY DEMANDS - The incumbent must spend long hours in intense concentration. The incumbent must also spend long hours on the computer entering information which requires attention to detail and high levels of accuracy.

MENTAL DEMANDS - There are a number of deadlines associated with this position, which may cause significant pressure. The incumbent must also deal with a wide variety of people on various issues.

REGULAR WORK SCHEDULE – Varies depending on business needs; however, the company's regular business hours are 8:00am to 5:00pm, Monday – Friday.