Medical Billing Specialist

Tal Healthcare • Full-time • West Hempstead, NY, US • $60k / year • 2w ago

Job Description

Our client, a national company servicing medical across the county and NY is seeking a Medical Billing and Follow-up Specialist.

Responsibilities

Creates and manages submission, intervention and resolution of bills, appeals, and grievances both electronically and manually
Conducts pertinent research, evaluates, responds and completes appeals and other insurance/policy guideline inquiries accurately, timely and in accordance with all established regulatory guidelines.
Prepares appeal documentation, summaries, correspondence, as well as documents information for tracking/trending data.
Review denied insurance claims, identify and resolve the issues in order to resubmit.
Develop strategies to reverse claim denials.
Manage and organize appeal workflow based on internal and insurance-driven deadlines.
Researches insurance policy language to determine medical necessity criteria.
Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research.
Collaborates with other team members to determine appropriate responses.
Prepare documentation for submitting bills/grievances/appeals.
Maintains current knowledge of regulatory billing requirements.
Monitors and tracks the number of appealed claims.
Assure timeliness and appropriateness of all appeals according to state, federal, and company guidelines.
Position can be a hybrid, two or three days in office.

Required Experience

Prior experience in the creation, submission, and completion of all hospital bills and insurance appeals.
Office administrative experience and the ability to work independently while effectively researching and maintaining the most current government laws and patterns of insurance denial, etc.
Familiarity with Commercial Insurance, Medicaid and Medicare claims denials and appeals processing, and knowledge of NCCI guidelines and LCD/NCD Edits for appeals and denials.
Familiarity with the Tri State Area Payers and Fiscal intermediary necessary

Desired Skills:

Computer literacy, especially with MS Office
Knowledge of Medicare and Medicaid rules and regulations.
Efficient multi-tasking.
Strong organizational skills
Ability to prioritize workload based on strict deadlines.
Attention to detail.
Effective organization of work assignments.
Effective written and oral communication.
Ability to self-motivate and learn quickly.
Ability to review and understand insurance policy language and guidelines.
Understand and comply with HIPAA regulations.

Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.