Job Summary:

The intent of this job description is to provide a summary of the major duties and responsibilities performed in this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.

The primary functions of the Billing Specialist II are charge review and claims and denial management in an assigned group or providers. The BS II will ensure tasks are completed with the greatest accuracy and efficiency. The incumbent will work denials and rejections to receive maximum reimbursement from payors and patients. The objective of the BS II is to submit clean claims, follow-up timely on accounts. and track accounts to resolution. Incumbent is responsible for addressing patient questions regarding account balances and statements with empathy and excellent customer service. Candidate will work optimally to achieve production expectations and report any patterns and trends noted in the AR to Leads. Other job duties as assigned.

Essential Job Duties: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Accurate identification and analysis of the claims listed on the A/R aging report. Makes corrective actions which result in an overturn of denials and payment approvals.
• Reviews medical documentation and billing for errors. Ensures a high percentage of claims are accepted by the payor on first submission.
• Prioritization of denied claims follow up, including accounts deemed uncollectible. Reviews contracted rates and allowable to ensure practice is realizing its expected rates.
• Corrects errors, re-files or appeals claims after verifying all the necessary billing information such as claims processing address and medical billing rules.
• Provides informed responses to patient questions and concerns by doing a thorough review of the account and account history.
• Works cooperatively with other teammates in all areas of revenue cycle. Creates opportunity for open communication with patients, providers, support staff and administration.
• Comply with all implicit and explicit company policies and procedures.

Required education and experience: The requirements listed below are representative of the knowledge, skills, and/or ability required.

Minimum Education required:

• High school graduate or higher
• Medical billing or coding certification preferred.
• Required 5 years of revenue cycle experience, urgent care preferred.
• Minimum 3 years of A/R Collections experience.
• Knowledge of Experity and/or Epic software is a plus.

Minimum Knowledge and Skills Required:

• Must have an advanced level of understanding in medical billing guidelines and regulations by CMS, OIG, commercial insurances, and other regulatory agencies.
• Must have advanced knowledge of payor types and payor specific billing rules.
• Basic knowledge of CPT, ICD-10, and HCPCS codes, modifier usage.
• Uses critical thinking and analytic skills to review accounts and patient charting.,
• Ability to communicate effectively, be courteous and tactful.
• Must be able to work independently and take initiative. Exhibits good judgement in daily activities.
• Superior customer service skills with patients and staff members in person and over the phone.
• Must have working experience in Office 365 business tools such as Outlook, Excel, Word, etc.
• Must have experience working in one or more Practice Management Systems. Must be able to conduct research in Health and payor systems.
• Ability to accept supervision and feedback.