About This Role
Managing and resolving insurance denials from various payers is the core of this billing specialist role, which also involves submitting electronic claims and maintaining accurate patient information. The position suits a candidate with experience in medical revenue cycle and a strong understanding of billing processes.
Responsibilities
- Submit, track, and reconcile electronic insurance claims
- Post insurance payments and contractual adjustments accurately and timely
- Review remittance advice and resolve payment discrepancies
- Identify, correct, appeal, and rebill denied or unpaid claims for Medicaid, Medicare, commercial, and managed care payers
- Verify insurance coverage and obtain required authorizations in accordance with payer requirements
- Maintain accurate patient demographic, insurance, and billing information within the EHR
- Utilize EHR and financial reports to identify and resolve documentation or service issues that impede billing
- Coordinate with clinical and administrative staff to ensure billing accuracy and compliance
- Assist the billing phone line and respond to client billing inquiries professionally and in a timely manner
- Prepare and distribute client billing statements
- Perform client account and ledger adjustments in accordance with organizational policy and payer guidelines
- Ensure compliance with all applicable regulatory, payer, and confidentiality requirements
- Other duties as assigned
Requirements
- Minimum of one year of outpatient medical revenue cycle experience
- Medical Billing, HIM, and/or Coding Certification
- One year of experience working Medicare, Medicaid, and third-party outpatient insurance claims and denials utilizing an EHR; or in lieu, a two-year degree in Medical Billing, HIM, or a Billing/Coding certification
- Knowledge of ICD-10CM, CPT, and HCPCS
- 21 years of age
- Negative Drug Screening prior to hire and throughout employment
- Clear Criminal Background Check throughout employment with Suncoast Center and local checks prior to hire and annually along with DCF Level II prior to hire and as required by DCF
- Valid Florida Driver's License
- Acceptable driving record maintained throughout employment
- Reliable vehicle, valid registration, and valid vehicle insurance
- Computer literate, including Excel spreadsheets, electronic claims processing with 837 and 835 files, website portal navigation, EHR comprehension, Microsoft Outlook
Nice to have:
- Behavioral health experience
- Experience in Behavioral Health Billing
