Medical Billing Specialist

About this role

Position Summary: We are actively seeking experienced and highly motivated Medical Billing Specialist (AR and Collections) to join our dynamic team. The successful candidate will play a crucial role in managing our collection processes for TDD services. The tasks include contract analysis, reimbursement, denial management, appeals, and resolving billing-related issues with insurance companies or other responsible parties for services rendered. The ideal candidate should possess in-depth knowledge of billing and collection practices and have a strong track record in resolving complex financial situations. Job Details: Medical Billing Specialist (AR and Collections) Work from home Monday to Friday | 9 PM to 6 AM (Manila Time) US Holidays & PH Regular Holidays Responsibilities: • Recognize and support patients’ rights and responsibilities in the performance of job duties, while respecting their privacy and confidentiality. • Follow up on submitted invoices to ensure prompt and timely payment, escalating issues as necessary. • Evaluate payments/denials received for correctness and ensure they are applied accordingly. • Identify bad debt write-offs and A/R adjustments. Initiate write-offs and adjustments in accordance with established policies and procedures. • Detect any overpayments and/or duplicate payments and investigate and resolve accordingly. • Process refund requests, in accordance with policies and procedures. • Maintain contact with other departments to obtain the patient or insurance information needed for claim payment. • Understand all procedures within regulatory mandates. • Ensure that the collection operations are conducted in a manner that is consistent with overall department protocol and follows Federal, State, and payer regulation, guidelines, and requirements. • Make calls to troubleshoot payment discrepancies and establish resolution. • Document, in detail, phone calls, phone numbers, persons spoken to, and call details on a consistent basis. • Consistently look for areas to maximize claim reimbursement. • Resolve issues that caused a denial within 5 days of receipt of denial. • Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations. • Understand NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies. • Maintain a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes. • Share knowledge gained with other staff members and work as a team member. • Interact with others in a positive, respectful, and considerate manner. • Perform other job-related duties as assigned. Qualifications: • 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. Originally posted on Himalayas

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