Job Description

Billing Specialist

This Billing Specialist is responsible for supporting the back-end billing, claims submissions, and overall claim integrity functions for RCM department within CityMD. The primary goal is to ensure the compliant, timely, and accurate management of all claim submissions impacting revenue for CityMD. The Billing Specialist would possess the knowledge and skill to deliver top services by fixing claim rejection & pending errors, resolving any claim edits, working all relevant billing reports and responding to inquiries from various stakeholders within the RCM department.

How You Will Get Things Done:

• Actively review patient accounts ensuring claims are accurate and billable
• Identify and resolve claim edits through understanding of billing guidelines and payer requirements
• Proactively fix claim rejection errors and resubmit claims based on payer requirements
• Comply with all Government and Third party payers regulatory mandated requirements for billing and collections
• Maintain all established trackers driving processes within the billing and submissions functions

How You Will Build Trust:

• Effectively participate during team meeting, payer discussions/meetings and conference calls/meetings as needed
• Ability to consistently maintain productivity and quality expectations as defined by management
• Alert management to irregularities, insurance trends and areas of concern with reimbursement
• Maintain communication with direct manager and/or any Team Leads and promptly follow-up with other departments as needed especially when seeking further information on delayed submissions
• Ability to maintain confidentiality of all information under HIPPA guidelines and policies and maintain PHI integrity

How You Will Innovate:

• Responsible for assisting all new Rev Cycle cross-team members in the onboarding and training process to educate new CityMD employees on Billing & Claim Submission Management
• Assists other departments within the Revenue Cycle department with various tasks/duties as assigned

Experience to Drive Change:

• High School Diploma, GED or Equivalent Required
• Minimum of 2-4 successful years in a business collection environment preferred
• Familiarity with MS Word, Excel, Google (GMAIL, G Drive) necessary
• Solid understanding of state laws and insurance fee schedules and their impacts on billing and collection
• Strong attention to detail
• Understanding how to read an EOB (Explanation of Benefits).
• Excellent organizational and multitasking skills
• Flexible and approachable to colleagues and inter-departmental stakeholders
• Enhanced communication and customer service skills.
• Ability to be self-directed, coupled with exemplary time management skills and the ability to simultaneously manage multiple tasks.
• Ability to perform functions at established CityMD RCM Support Center
• Prior medical billing experience and healthcare insurance knowledge a plus

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