Billing Specialist

Office Location: Williamsville, NY
Status: Full Time
Salary: Commensurate with Experience

Job Description:

Essential Functions

Cooperation and teamwork with rotating tasks within billing department including, but not limited to:

1. Accounting

a.      Rectify and Balance checks to accounts.

b.      Various accounting duties as assigned.

2. Follow Up on Open Claims

a.      Explore and resolve any denied, incorrectly paid or no response claims.

b.      Complete verbal or written insurance company inquiries.

3. Obtaining Authorizations

a.      Ensure prior authorizations (PA) are in place and well documented for all exams requiring PA as noted by insurance carrier.

b.      Decipher, understand and document proper exam and prior authorization in place prior to patient appointment date.

c.      Verify correct coding, billing information.

d.      Communicate within and across departments, with patients, and insurances to obtain appropriate information required for claims submission.

e.      Notify appropriate departments of pending, approved and denied exams.

f.       Develop and maintain positive rapport with both internal and external customers to ensure proper documentation and authorizations in place.

4. Medicaid Reimbursement

a.      Checks to ensure patient records include all required information

b.      Verifies correct Medicaid coding to ensure proper payment.

c.      Submit all claims with appropriate reports and drug sheets when needed.

d.      Input correct billing information and transmit electronically to carrier.

e.      Consults with claims clerks in Medicaid office about any disputed claims, and follows up on all bills not processed within usual claim period.

f.       Reviews remittance advice forms to determine any adjustments made to bills as submitted and consults with Medicaid as required.

g.      Authorizes and makes adjustments to patient bills to correct any error.

5. Problem Solving

a.      Follow up on and investigate open, denied and underpaid claims.

b.      Ability to explore and resolve issues relating to open claims.

c.      Utilizes appropriate tools to investigate and resolve billing issues.

d.      Investigate and resolve open claims with insurance carriers, patients and referring physicians as necessary.

e.      Adhere to and uphold all HIPAA and New York State regulations regarding patient privacy as well as standards of ethics set forth by Windsong Radiology Group.

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