Job Description

Job Description

Job Description

Description:

Job Description

Position: Medical Billing Specialist

Department: Revenue Cycle Management/Revenue Cycle Services

Supervisor: Billing Manager

Employment Type: Full-Time

Scope: We are seeking an experienced Medical Billing Specialist to join our billing team. The ideal candidate would have a background in the medical billing processes, excellent communication skills, and the ability to handle complex billing tasks efficiently. This role involves resolving billing errors, interacting with patients and various clients, and ensuring an accurate and timely billing practice.

CLIA Responsibilities: This is not a CLIA regulated position.

Duties / Responsibilities:

1. Patient and Business Communication:
2. Answer billing questions for patients and businesses.
3. Take credit card payments over the phone and provide billing support as required.
4. Check and reply to emails related to billing inquiries and updates.

1. Error Handling and Insurance Verification:
2. Work on queues to resolve various billing errors, i.e. missing information, insufficient demographics and invalid codes.
3. Check various insurance portals to verify insurance details and reach out to collectors for necessary information.

1. Claims Processing and Order Verification:
2. Verify insurance coverage, claim details, and order accuracy for each transaction.
3. Address errors and missing information with accessioning, sales teams, and other stakeholders.

1. RCS Assistance:
2. Assist the RCS Team in obtaining accurate information for billing efficiency, i.e. missing/invalid insurance information, demographic information, medical records and diagnosis codes.

1. Mail Handling (Part Time):
2. Daily mail pick-up and drop-off
3. Opening, sorting, and scanning mail.
4. Process claims to be mailed.

1. Document Management (Part Time):
2. Scan all paper requisitions, demographics, chart notes into LIS system and RCS system.
3. Oversee document manager, i.e. uploading, redacting, and attaching.

1. Medical Records (Part Time):
2. Support in working medical records requests, i.e. request for lab requisitions, results, chart notes and ensure they are received by the requester.

Additional duties may be assigned to meet organizational needs.

Success Indicators: The Billing Manager will perform annual performance evaluations for this role, in addition to performing periodic assessment of on-going projects as needed.

Key performance success indicators include, but are not limited to:

Data Integrity and Accuracy

• Low Error Rate: Minimal data entry errors or discrepancies.

Regulatory Compliance

• Audit Readiness: The Billing Department consistently meets regulatory requirements, ensuring the department is always prepared for audits.
• Positive Audits Outcomes: Successful audits with no significant findings related to compliance, CMS, and HIPAA guidelines.
• Proper Documentation: All necessary documentation is current and compliant with regulatory standards.

User Satisfaction, User Training & Cross-team Coordination

• High User Proficiency: Users demonstrate strong competency and confidence in using the LIMS, RCS and other software systems as reflected in feedback and performance.
• Effective Training: Training programs are well-received, with billing staff able to efficiently use all necessary software systems.
• Responsive Support: Timely and effective resolution of queries and issues, with positive feedback from stakeholders and colleagues.
• Effective Collaboration: Consistently and effectively collaborates with the billing team, third-party billing administrators, and other relative departments receiving positive feedback on communication and teamwork.

System Optimization and Efficiency

• Timely Project Completion: Billing related projects are completed on schedule.
• Innovation: Implementation of new features or processes that enhance billing functionality, efficiency, or lab operations.
• Proactive Issue Management: Early identification and mitigation of potential issues before they impact laboratory operations.

Documentation

• Accurate Documentation: All billing-related documentation is accurately recorded and easily accessible.

Supervisory Responsibilities: This role does not include supervisory responsibilities.

Required Skills / Abilities:

• Knowledge of HIPAA regulations.
• Strong communication and training skills.
• Attention to detail and ability to prioritize tasks effectively.
• Excellent problem-solving, communication, and project management skills.
• Ability to work collaboratively with cross-functional teams.

Qualifications:

• High school diploma or equivalent; relevant certification in medical billing is a plus.
• Minimum of [X] years of experience in medical billing.
• Proficiency in billing software and systems (i.e., Telcor and Waystar).

Benefits:

Health Insurance

Dental Insurance

Vision Insurance

Life & AD&D Insurance

Retirement Plan, 401(K)

Paid Time Off and Sick Leave

Specialized Paid Leave

Gym/Wellness Membership

Employee Assistance Program

Educational Assistance & Career Advancement Training

Active Team Building Festivals & Parties

Company Culture: Southwest Labs core values are not just abstract concepts; they are practical guidelines that shape every aspect of a laboratory’s operation, from daily routines to long-term goals and achievements. They create a framework that ensures scientific excellence, ethical conduct, effective teamwork, and continual growth and improvement. All team members are expected to consistently uphold and demonstrate these values.

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