Medical Billing Specialist na PRIMARY CARE PARTNERS INC

Description

✨ Why Join Primary Care Partners? We Take Care of You While You Care for Others! ✨

At Primary Care Partners, we believe that taking care of our team is just as important as taking care of our patients. That’s why we offer:

• 💯 100% Employer-Paid Health Insurance Premiums – Your health matters to us.
• 🏖️ Paid Vacation and Sick Time – Because rest and recovery are essential.
• ⚖️ A Strong Commitment to Work-Life Balance – We strive to create a positive, supportive environment where every individual can thrive both professionally and personally.

                                                                        Medical Billing Specialist

Job Summary

The Medical Billing Specialist is responsible for managing patient accounts and ensuring accurate and timely billing processes. This role requires strong decision-making and problem-solving skills, with the ability to analyze key information, explore alternatives, and implement effective solutions. The position involves direct interaction with patients both in-person and over the phone, requiring exceptional customer service skills.

Key Responsibilities

Patient Account Management

• Enter charges and payments accurately
• Audit patient accounts for accuracy
• Verify demographic and billing information to secure payment
• Assist patients with setting up budget payment plans
• Accept and process patient payments
• Manage past-due accounts and initiate collection efforts
• Mail billing correspondence to patients

Demographic & Insurance Management

• Create accounts for new patients
• Determine and verify current insurance coverage
• Update patient demographics via Phreesia (automated intake platform)
• Add or remove insurance information as needed

Customer Service

• Handle up to 40 patient calls per day
• Explain statements, deductibles, copays, and coinsurance
• Process payments over the phone
• Address account issues from correspondence or calls
• Monitor and correct duplicate accounts
• Split family accounts as needed
• Request refunds for accounts with negative balances

Charge Entry

• Review submitted charges for accuracy across 9 clinics
• Audit charts for missed charges
• Add/remove CPT, ICD-10, HCPC, and modifier codes
• Run validation and verification reports
• Review claims for common errors and apply appropriate modifiers

Payment & Adjustment Posting

• Post insurance and patient payments (manual and electronic)
• Research denials and aging accounts
• Communicate with insurance companies for claim resolution
• Submit corrected claims and process refunds
• Adjust small, uncollectable balances
• Import electronic remittance files

Payment: Reconciliation & Reporting

• Reconcile daily payments for the billing office and across 9 clinic locations.
• Submit check payments electronically to the bank.
• Prepare deposits for cash payments.
• Generate monthly and yearly reports detailing charges, payments, adjustments, and refunds.

Claims & Statement Processing

• Submit patient statements to clearinghouse
• Validate and print claims for paper submission
• Review and correct failed or rejected claims
• Resubmit corrected claims for various errors (e.g., coding, insurance ID, COB)

Collections Management

• Contact patients with past-due accounts
• Process bankruptcies, affidavits, and credit counseling
• Maintain logs for cash box, NSF checks, and address changes
• Manage statement holds, deceased accounts, and payroll deductions
• Coordinate with the collection agency concerning accounts that have been resolved or finalized.

Collections Management

• Manage all internal clinic phone communications related to billing.
• Respond to billing and insurance inquiries from front desk staff across all locations.
• Enter new insurance information into the system.
• Verify eligibility for newly added insurance plans.
• Provide guidance to front office staff regarding insurance providers and payment policies.
• Address front desk tasks related to self-pay patients when charges are unavailable at checkout.
• Contact patients to collect self-pay charges once billing has been completed.

Work Experience

• Experience in healthcare billing is preferred but not required.
• Experience in charge entry, payment processing, denial management, customer service, and collections.

Education Requirements

• High School Diploma required.
• Associate’s degree or certification in healthcare/business-related field preferred but not required. Additional relevant experience may substitute for formal education

General Requirements

• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills
• Problem solving skills
• Ability to manage multiple tasks and prioritize effectively
• Positive, customer-focused demeanor
• Ability to work independently and collaboratively

Position Type & Hours

Full-time, 40 hours/week, Monday–Friday, 8:00 a.m. – 5:00 p.m. Hours may change with or without notice

Working Environment

Professional office setting, primarily desk-based with phone and computer work in a well-lit and ventilated environment

Physical Demands

Regular talking and hearing
Primarily sedentary with occasional walking and light lifting
Visual requirements include close, distance, and color vision, and focus adjustment

Other Duties

This job description is not exhaustive and may be updated at any time to reflect changing responsibilities and organizational needs.

Qualifications

Work Experience

• Experience in healthcare billing is preferred but not required.
• Experience in charge entry, payment processing, denial management, customer service, and collections.

Education Requirements

• High School Diploma required.
• Associate’s degree or certification in healthcare/business-related field preferred but not required. Additional relevant experience may substitute for formal education

General Requirements

• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills
• Problem solving skills
• Ability to manage multiple tasks and prioritize effectively
• Positive, customer-focused demeanor
• Ability to work independently and collaboratively