Summary: The Billing Specialist may be required to fulfill key billing aspects including but not limited to: primary and secondary claims per regulations and policies, re-processing of denials of claims, and ensuring billing and coding are accurate and correct.

Essential Duties/Responsibilities:

• Greet and provide assistance, guidance and direction to visitors and clients.
• Responsible for the submission or resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
• Ensures billing and coding are correct prior to sending appeals or reconsiderations to payers.
• Complete insurance verification.
• Investigate un-adjudicated claims and complete appropriate follow-up
• Clearly document issues and resolution.
• Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.
• Maintains confidentiality and adheres to all HIPAA guidelines/regulations.
• Exhibit exceptional customer service skills; answering patient and insurance calls; prompt return and follow up to all interactions; prompt response to requests for information.

Non-Essential Duties/Responsibilities: 

• Collaborate with Finance Director to coordinate yearly LifeCare enrollment 
• Performs other duties as required. 

Required Competencies and Experience:

• Strong understanding of physiology, medical terms and anatomy
• Strong knowledge of medical billing and coding procedures.
• Associate’s degree or higher and/or two years of equivalent experience 
• Minimum of 1 years’ experience in any medical billing and coding industry

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer. 
• Must be able to lift 15 pounds at times.  

Working Environment: 

• Standard working hours: Monday to Friday, 8:00 AM – 5:00 PM 
• Based in a professional office setting