Billing Specialist II

Summary

Clearway Pain Solutions is seeking a Billing Specialist II for its Billing department. This remote role supports timely revenue collection by handling patient and charge entry, tracking high-dollar claims, resolving denials and carrier issues, and maintaining accurate billing and claims records.

Responsibilities

• Reviews and resolves complex issues that result in payer denials, including appeals, coding corrections, medically necessity rules and other related functions
• Assists the auditor in reviewing notes for medical necessity
• Works with the authorization department to resolve authorization issues with complex procedures
• Runs and maintains tracking logs to track complex high dollar procedures and report the results to the billing department management team
• Contacts the various Provider Service Representatives to resolve repetitive payment issues
• Acts as a resource for the Billing Staff for complex issues
• 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
• Helps train new revenue cycle staff
• Collects and reviews end of day reports
• Checks work e-mail on a regular basis throughout the workday
• 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 five (5) 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
• * Two (2) years' experience working with an Electronic Medical Record (EMR)
• * Medical Billing Certification
• 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

Qualifications

Must Haves

• * High School Diploma, or equivalent WITH a minimum of five (5) 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
• * Two (2) years' experience working with an Electronic Medical Record (EMR)
• * Medical Billing Certification
• 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

Benefits

• PTO: Up to 96 hours in first year (pro-rated based on start date)
• 7 holidays: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day
• 401(k) with employer match
• Medical (single and family)
• Dental (single and family)
• Vision (single and family)
• Short-Term Disability
• Long-Term Disability
• Basic Life/AD&D
• Employee Assistance Program
• Voluntary Life
• Accident
• Critical Illness
• Hospital Indemnity
• Eligible for overtime pay in accordance with applicable law