Billing Specialist

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Billing Specialist

The Billing Specialist is responsible for retrieving all billable charges, timely submission of claims, follow-up on unpaid claims, and answering patient questions regarding their statements within the OCHIN Epic System. This position is responsible for all payers, including Medicare, Medicaid, managed care, commercial insurance, workers’ compensation, and private pay. The Billing Specialist’s role focuses on maximizing revenue and cash flow by completing these tasks promptly and efficiently. Maintain a designated level of collections through payments and ensure complete follow-through on all denied or rejected claims. Follow up and collect all outstanding receivables from payers and patients, and provide excellent customer service to internal and external customers.

Position-Specific Competencies/Essential Functions/Duties& Responsibilities:

• Retrieve all billable charges within 72 hrs.
• Review, resolve, and bill all outstanding statuses promptly.
• Direct contact with patients to resolve all inquiries on their account(s).
• Monitoring patient account activity through queries and statement review.
• Monitor and maintain the AR Aging Report to achieve department goals.
• Independently resolve follow-up issues related to their work assignments.
• Review, revise, re-process, and follow up on all denials and system-rejected claims.
• Process appeals promptly in accordance with the payer contract.
• Process all patients and insurance refunds.
• Ability to run reports with OCHIN Epic.
• Clear and complete documentation of all accounts worked.
• Utilize extra time during decreased workload to assist in other department projects.
• Contribute to the Billing Department team through a positive attitude, respectful interaction, innovative ideas, efficiency, and ethical behavior.
• Participates in educational activities and attends staff meetings
• Maintains strict confidentiality; adheres to all HIPAA and PHI guidelines/regulations.

Required Knowledge, Skills, and Abilities:

• Must have 3+ years of experience working in a physician or hospital collection setting; knowledge of ICD-10, CPT Codes, and HCPC Codes
• Knowledge of insurance carriers (Medicare, Medicaid, managed care, commercial insurance, and workers’ compensation) payment regulations, including various reimbursement schemes, co-insurance, deductibles, contractual adjustments, and sliding fee
• Possess a working knowledge of practice management systems (OCHIN Epic) and Microsoft Office
• Working knowledge of HIPAA and PHI regulations and compliance
• Strong interpersonal and communication skills, and can work successfully in a team-oriented environment
• High attention to detail and the ability to multitask
• Hours: may vary based on organizational needs
• Travel: may vary based on organizational needs

Qualifications:

• Minimum education Level: High School Diploma
• Minimum 3 years of experience in a FQHC, clinic, physician’s office, or hospital setting.

Milwaukee Health Services, Inc. is an equal opportunity employer.
Milwaukee Health Services, Inc. does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or veteran status.

 

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