Medical Billing Specialist

Position Summary:

We are actively seeking experienced and highly motivated Medical Billing Specialist (AR and Collections) to join our dynamic team. The successful candidate will play a crucial role in managing our collection processes for TDD services. The tasks include contract analysis, reimbursement, denial management, appeals, and resolving billing-related issues with insurance companies or other responsible parties for services rendered. The ideal candidate should possess in-depth knowledge of billing and collection practices and have a strong track record in resolving complex financial situations.

Job Details:

Medical Billing Specialist (AR and Collections)

• Work from home
• Monday to Friday | 9 PM to 6 AM (Manila Time)
• US Holidays & PH Regular Holidays

Responsibilities:

• Recognize and support patients’ rights and responsibilities in the performance of job duties, while respecting their privacy and confidentiality.

• Follow up on submitted invoices to ensure prompt and timely payment, escalating issues as necessary.

• Evaluate payments/denials received for correctness and ensure they are applied accordingly.

• Identify bad debt write-offs and A/R adjustments. Initiate write-offs and adjustments in accordance with established policies and procedures.

• Detect any overpayments and/or duplicate payments and investigate and resolve accordingly.

• Process refund requests, in accordance with policies and procedures.

• Maintain contact with other departments to obtain the patient or insurance information needed for claim payment.

• Understand all procedures within regulatory mandates.

• Ensure that the collection operations are conducted in a manner that is consistent with overall department protocol and follows Federal, State, and payer regulation, guidelines, and requirements.

• Make calls to troubleshoot payment discrepancies and establish resolution.

• Document, in detail, phone calls, phone numbers, persons spoken to, and call details on a consistent basis.

• Consistently look for areas to maximize claim reimbursement.

• Resolve issues that caused a denial within 5 days of receipt of denial.

• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.

• Understand NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.

• Maintain a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.

• Share knowledge gained with other staff members and work as a team member.

• Interact with others in a positive, respectful, and considerate manner.

• Perform other job-related duties as assigned.

Qualifications:

• A high school diploma or general education degree (GED) equivalent.

• At least 3 years of medical billing and collections experience.

• Home Infusion experience, hospital or chemotherapy experience is required.

• Experience in calculating drug units, Intrathecal Pain Management is a plus.

• Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.

• Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.

• Strong work ethic with personal qualities of integrity and credibility.

• Self-directed, detail-oriented, conscientious, organized, and able to follow through.

• Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.

• Tolerance of frequent interruptions and distractions from staff and other internal support teams.

• Proficiency in Microsoft Office, including Outlook, Word, and Excel.