Medical Billing Specialist
Reports To: Billing Manager
Responsible for all aspects of the billing process for Breastfeeding Success. Performs a range of routine insurance processing for the following service types: outpatient, inpatient, telemed and classes. Manages any and all insurance correspondence, including requests for medical records, refunds and correction of claims. Has a deep understanding of compliance and insurance reimbursement best practices. Is proficient with spreadsheets and other software tools. Has gained proficiency in multiple competencies relevant to the job. Works independently within established procedures associated with the specific job function.
Duties and Responsibilities:
Insurance Claims Processing – managing all aspects related to insurance claims; independent decision-making and direct contact with insurance carriers from beginning to resolution.
Verify insurance eligibility and benefits for services with payers via online payer portals, calling payers, and/or faxing requests.
- Updating patient demographics utilizing Compass and Epic in order to submit clean claims to insurance companies
- Resolve rejected claims with insurance providers
- Obtain hospital authorizations from Epic and Compass for BCBS Advantage and enter into Athena for billing
- Ensure patient obtains any required authorizations from PCP; work alongside Administrative Assistants on referral and authorization process
- Reach out to patients to obtain correct insurance information or to resolve patient-related denials
Accounts Receivable– Managing all aspects of client and insurance Accounts Receivable department; independent decision-making regarding Accounts Receivable projects and goals.
- Monitor aged Accounts Receivable and resolve unpaid claims
- Direct and independent follow-up with clients for collection of deductible, co-pay, and coinsurance
- Credit card processing and posting
- Responsible for handling any and all patient billing questions for all service types including breast rental pumps and scales
- At least 3-5 years of medical insurance claim processing experience; Athena experience required
- At least 2 years of primary care or ob/gyn experience preferred
- Knowledge or experience in credentialling preferred
- Proficient with Excel spreadsheet analysis
- Detail Oriented
- Ability to work independently without direct daily supervision but able to work well with a team
- Austin Based hybrid/remote position