Billing Specialist I

Summary

Clearway Pain Solutions is a healthcare organization providing pain management services. The Billing Specialist I supports timely revenue collection by accurately entering patient and charge information, managing claims, resolving denials, and following up on outstanding accounts.

Responsibilities

• Reviews and resolves payer denials, including appeals, coding corrections, medically necessity rules and other related functions
• Analyzes and resolve billing issues, keeping A/R to no more than 10% over 60 days
• Processes daily correspondence, claim status, handle denials, appeals and re-bills
• Answers billing questions and inquiries from patients and internal staff
• Updates patient files with address changes, contact information changes, etc., as needed
• Reviews all policy changes on a regular basis and informs supervisor and charge entry specialist of such changes
• Efficiently navigates assigned insurance companies' proprietary websites to find policies, research payments, etc
• Keeps supervisor apprised of matters regarding accounts receivable
• Responds to requests from billing company in a timely fashion
• Researches denials and submits correct claims/medical documentation
• Reviews and manages claims within the work dashboard hold buckets for resolution
• Creates, maintains and updates reports, as directed
• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations
• Participates in and complete all required trainings and in-services
• Performs other duties as assigned

Skills

• High School Diploma, or equivalent WITH a minimum of three (3) years related experience; OR an equivalent combination of education and/or experience
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook)
• Must have excellent written and oral communication skills, including exceptional customer service
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public
• Must be able to work individually as well as within a team
• Must be able to follow both verbal and written instructions
• Must be able to work a flexible schedule
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations
• Must be able to multi-task and prioritize
• Must demonstrate extreme attention to detail
• Must possess strong organization skills
• Must be able to problem solve and use reasoning
• Must be able to meet predefined quality standards
• Must maintain and project a professional attitude and appearance at all time
• Must have a working knowledge of CPT and ICD-10 coding rules
• Must have a solid foundation of insurance knowledge and guidelines for third party payers
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance
• Candidates must live in one of the states where we currently operate: MD, DE, VA, NJ, PA, FL, AL, GA, SC, and TX
• The employee must have reliable transportation. While the primary workplace may be closest to the employee's home, work assignments could be in any of the Company's locations
• Two (2) years' experience working with an Electronic Medical Record (EMR)
• Medical Billing Certification

Qualifications

Must Haves

• High School Diploma, or equivalent WITH a minimum of three (3) years related experience; OR an equivalent combination of education and/or experience
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook)
• Must have excellent written and oral communication skills, including exceptional customer service
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public
• Must be able to work individually as well as within a team
• Must be able to follow both verbal and written instructions
• Must be able to work a flexible schedule
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations
• Must be able to multi-task and prioritize
• Must demonstrate extreme attention to detail
• Must possess strong organization skills
• Must be able to problem solve and use reasoning
• Must be able to meet predefined quality standards
• Must maintain and project a professional attitude and appearance at all time
• Must have a working knowledge of CPT and ICD-10 coding rules
• Must have a solid foundation of insurance knowledge and guidelines for third party payers
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance
• Candidates must live in one of the states where we currently operate: MD, DE, VA, NJ, PA, FL, AL, GA, SC, and TX
• The employee must have reliable transportation. While the primary workplace may be closest to the employee's home, work assignments could be in any of the Company's locations

Nice to Haves

• Two (2) years' experience working with an Electronic Medical Record (EMR)
• Medical Billing Certification

Benefits

• This is a remote position.
• PTO: Up to 96 hours in first year (pro-rated based on start date)
• Holidays: 7 (New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement: 401(k) with employer match
• Health Benefits: Medical (single and family), Dental (single and family), Vision (single and family)
• Other Company-Paid Benefits: Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
• Other Voluntary Benefits: Voluntary Life, Accident, Critical Illness, Hospital Indemnity
• This position is non-exempt (hourly) and eligible for overtime pay in accordance with applicable law.