Billing Specialist

Job Description

Job Description

Job Description

Developmental Pathways is seeking an experienced Medical Biller with experience in ABA services to work in our administrative office. The ideal candidate will have a strong background in medical billing, with the skills necessary to improve our current billing procedures and reduce A / R days. The successful applicant will work on a number of tasks requiring data analysis, in-depth evaluation and exercising judgement within the appropriate scope of practice. We offer excellent benefits, generous paid time off and competitive compensation.

Responsibilities :

• Audits and corrects all claims on UB04 and / or CMS 1500 format.
• Review all EOB’s received in the mail that require attention.
• Complete data entry of all patient demographics, guarantor, and insurance information.
• Post procedures and insurance.
• Manage relationships with various Insurance payers.
• Call insurance companies to resolve billing issues.
• Call for Verification of Benefits.
• File claims to ensure maximum entitled reimbursement.
• Follow orders of detailed work activity.
• Ensure all claims are submitted with a goal of zero errors.
• Verify completeness and accuracy of all claims prior to submission.
• Meet all deadlines given.
• Read and interpret insurance explanation of benefits.
• Respond to inquiries from insurance companies, patients, and providers.
• Regularly meet with Financial Manager to discuss and resolve reimbursement issues or billing obstacles.
• Attend monthly staff meetings and continuing educational sessions as requested.
• Perform additional duties as requested by Director or Management team.
• Obtaining referrals and pre-authorizations as required for procedures.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Following up on unpaid claims within standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances.
• Researching and appealing denied claims.
• Setting up patient payment plans and work collection accounts.
• Updating billing software with rate changes.
• Updating cash spreadsheets and running collection reports.

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