Medical Billing Specialist
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Job Description
Medical Billing Specialist managing TDD infusion-service claims, reimbursements, denials, and collections for A-AIS. Resolving insurance payment issues while ensuring HIPAA and regulatory compliance.
Responsibilities:
- Manage collection processes for TDD services.
- Analyze contracts and reimbursement.
- Manage denials and appeals.
- Resolve billing-related issues with insurance companies or other responsible parties.
- Follow up on submitted invoices to ensure prompt and timely payment, escalating issues as necessary.
- Evaluate payments and denials for correctness and apply them accordingly.
- Identify bad debt write-offs and accounts receivable adjustments; initiate them according to established policies and procedures.
- Detect, investigate, and resolve overpayments and duplicate payments.
- Process refund requests according to policies and procedures.
- Obtain patient or insurance information needed for claim payment through coordination with other departments.
- Ensure collection operations comply with department protocol and federal, state, and payer regulations, guidelines, and requirements.
- Call to troubleshoot payment discrepancies and establish resolutions.
- Document phone calls, phone numbers, persons spoken to, and call details.
- Maximize claim reimbursement.
- Resolve denial-causing issues within 5 days of receiving denials.
- Maintain patient confidentiality and adhere to HIPAA guidelines and regulations.
- Apply knowledge of NDC numbers, metric quantities, infusion supplies, insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
- Share knowledge with staff members and work as a team member.
- Perform other job-related duties as assigned.
Requirements:
- A high school diploma or general education degree (GED) equivalent.
- At least 3 years of medical billing and collections experience.
- Home Infusion experience, hospital or chemotherapy experience is required.
- Experience in calculating drug units.
- Intrathecal Pain Management is a plus.
- Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
- Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
- Strong work ethic with personal qualities of integrity and credibility.
- Self-directed, detail-oriented, conscientious, organized, and able to follow through.
- Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
- Tolerance of frequent interruptions and distractions from staff and other internal support teams.
- Proficiency in Microsoft Office, including Outlook, Word, and Excel.
- Ability to work Monday to Friday, 9 PM to 6 AM Manila Time.
Benefits:
- Work from home
- Monday to Friday schedule
- US Holidays & PH Regular Holidays
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