- Prepare and submit medical insurance claims to insurance companies or government agencies for reimbursement.
- Verify patient insurance coverage, eligibility, and benefits to ensure accurate claim submission.
- Review claim denials, identify reasons for rejection, and resubmit claims with necessary corrections and documentation.
Billing and Coding:
- Assign appropriate medical codes (e.g., CPT, ICD-10) to diagnoses, procedures, and services performed by healthcare providers.
- Ensure accuracy and compliance with coding guidelines, regulations, and payer requirements.
- Generate patient statements, invoices, and billing statements for services rendered, including co-pays, deductibles, and outstanding balances.
Payment Posting and Accounts Receivable Management:
- Post payments, adjustments, and refunds to patient accounts and reconcile accounts receivable records.
- Follow up on unpaid claims, overdue accounts, and outstanding balances with insurance companies and patients.
- Resolve billing discrepancies, insurance inquiries, and payment disputes in a timely manner to facilitate prompt payment.
Patient and Provider Communication:
- Communicate with patients regarding billing inquiries, insurance coverage, and payment options.
- Collaborate with healthcare providers and office staff to resolve billing issues, clarify coding discrepancies, and ensure accurate billing practices.
- Educate patients on their insurance coverage, financial responsibilities, and billing processes.
Compliance and Documentation:
- Maintain patient confidentiality and comply with HIPAA regulations and other healthcare privacy laws.
- Keep abreast of changes in medical billing regulations, coding guidelines, and insurance policies.
- Document billing activities, communications, and claim status updates accurately and comprehensively.
Requirements
- High school diploma or equivalent required; Associate degree or certification in Medical Billing and Coding preferred.
- 2+ years of experience in medical billing and coding, preferably in a healthcare setting such as a hospital, clinic, or medical office.
- Proficiency in medical billing software and electronic health record (EHR) systems, such as Epic, Cerner, or Meditech.
- Knowledge of medical coding systems, including CPT, ICD-10, HCPCS, and medical terminology.
- Understanding of insurance billing and reimbursement processes, including Medicare, Medicaid, commercial insurance, and third-party payers.
- Strong attention to detail and accuracy in coding, billing, and documentation.
- Excellent communication and interpersonal skills, with the ability to interact professionally with patients, providers, insurance companies, and colleagues.
- Analytical and problem-solving abilities, with the capacity to resolve billing discrepancies, claim denials, and payment disputes.
- Ability to prioritize tasks, manage time effectively, and meet deadlines in a fast-paced, deadline-driven environment.
- Commitment to compliance with regulatory requirements, ethical standards, and industry best practices in medical billing and coding.
