Job Description

Job Title: Medical Billing Specialist
Location: Livermore, CA – Onsite – Local candidates only
Period: - possibility of extension
Hours/Week: 40 hours (Hours over 40 will be paid at Time and a Half)

Rate: $25 /hr 

Contract Type: W-2

 
Scope of Services:

The Medical Billing Specialist is a pivotal member of our team, ensuring that the company meets its monthly financial goals. This role requires a diverse skill set and competencies to effectively communicate, negotiate, analyze, and resolve issues with payers and patients while adhering to HIPAA and PHI regulatory requirements.

 
Role, Responsibilities, and Deliverables:

• Ensure compliance with HIPAA and PHI regulatory policies and practices throughout all phases of client information processing.
• Report any compliance issues to the Director of Operations promptly.
• Coordinate the insurance verification process, ensuring clarity for clients regarding their co-pay responsibilities.
• Facilitate the collection of co-pays through timely follow-up.
• Gather credit card or other payment processing information from clients as necessary and enter it into the system for payment processing.
• Manage the timely entry of client information into the computer system, ensuring accuracy and completeness, and obtain any missing information needed to set up clients for service.
• Confirm all sales orders in the system and ensure that all required documentation (e.g., proof of delivery, signed prescriptions, signed acknowledgment forms) is on file before submitting claims for payment.
• Follow up on missing sales orders and reconcile billing questions regularly until payment status is complete.
• Submit claims (electronic and paper) to payers in a timely manner, correcting and resubmitting front-end and back-end rejected claims as needed.
• Ensure all cash is posted to the correct account promptly.
• Follow up and collect payments due to the organization in a timely manner by generating invoices and following up with clients and/or payers.
• Stay updated on current regulatory guidelines and reimbursement information to ensure accurate billing and reimbursement.
• Perform other duties/projects as assigned by management, including customer service support, processing, resolving, and logging customer inquiries.

 
Key Skills and Competencies:

• Attention to detail, ensuring accuracy in all tasks.
• Excellent communication and listening skills.
• Proficient in documenting accounts with detail and critical thinking.
• Ability to read an explanation of benefits (EOB).
• Strong analytical skills for effective collections management.
• Familiarity with various tools and systems used in medical billing.
• Proven problem-solving skills to overcome challenges in the billing process.
• Exceptional customer service skills to maintain positive relationships with customers and payers.
• Effective time management to prioritize tasks and meet deadlines.
• Excellent attendance record.

 
Education & Experience:

• Minimum of 2 years of experience in medical billing or related field.
• Proficiency in medical billing software systems such as [insert specific software names].
• Demonstrated understanding of HIPAA and PHI regulatory requirements.
• Experience in coordinating insurance verification processes and managing co-pay collections.
• Proven track record of accurately entering and managing client information in computer systems.
• Familiarity with claim submission processes and experience in correcting and resubmitting rejected claims.
• Strong communication skills with the ability to effectively interact with clients, payers, and internal teams.
• Prior experience in handling customer inquiries and providing excellent customer service.
• Ability to work independently and as part of a team in a fast-paced environment.
• Previous training or certification in medical billing or related field is a plus.

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