Medical Billing Specialist
CurrentSUMMARY: As a Medical Billing Specialist, I'm responsible for coding and billing along with conducting insurance verifications and obtaining the necessary letters of agreement from doctor's offices before dispensing medications to patients. I've strong attention to detail, excellent communication skills, and the ability to navigate insurance systems and requirements. My contributions will ensure a smooth medication dispensing process and adherence to company guidelines. DUTIES AND RESPONSIBILITIES:Analyze and appropriately diagnose rejected claim problems, leveraging strong knowledge of CPT, HCPCS, modifiers and ICD-10 codes.Contact insurance companies to understand next steps available to obtain payment. Review documentation to understand incorrect information obtained or documented from insurance companies during the benefit investigation process.Handle prescriber and field escalations.Audit Summary of Benefits, conducting further research when needed.Obtain necessary letters of agreement from providers prior to dispensing medications.Ensure compliance with insurance regulations and policies to avoid potential billing errors and reimbursement delays.Provide support to billing and administrative teams to ensure accurate and timely insurance billing. Liaison with other program resources to secure outcomes for active patients.Ensures protection is insured.Performs other related duties as assigned by management.SKILLS: o Experience in Medical, A/R, billing and collections o Specialized knowledge of contracts, regulatory or contractional billing guidelineso Identifying and securing duplicate billings, coordination of benefits, medical records or clinical documents to expedite payment of insurance claims.o Resolving inappropriate payments not in compliance with payer contracts or governmental agency rates.
