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    Medical Billing Specialist - Doral, United States - NeueHealth

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    Description

    JOB SUMMARY


    The Medical Billing Specialist is responsible for the accuracy of the super bill/claim prior to transmission to payer, including validation of appropriate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

    DUTIES & RESPONSIBILITIES


    The Billing Specialist job description is intended to point out major responsibilities within the role, but it is not limited to these items.


    • Assign/remove CPT, HCPCS and modifiers as part of the super bill/claim validation process.
    • Prepare and review super bill/claims prior to submission.
    • Identify coding trends and opportunities to improve quality, efficiency and productivity.
    • Checking each insurance payment for accuracy.
    • Ensure compliance with billing and payers' guidelines.
    • Calling insurance companies regarding any discrepancy in payments if necessary
    • Researching and appealing denied claims.

    EDUCATION AND PROFESSIONAL EXPERIENCE
    (Licensures AND Certifications)


    • High school diploma or GED equivalent
    • Minimum of 1 year of experience as a medical biller.

    PROFESSIONAL COMPETENCIES

    • Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
    • Knowledge of CPT, ICD-10-CM and HCPCS codes.
    • Knowledge of coding principles and guidelines.
    • Knowledge of billing principles and guidelines.
    • Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.
    • Excellent written and verbal communication skills
    • Prefer certification as any of the following - American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC) or American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS).
    • Bilingual English and Spanish required.

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