Billing and Claims Specialist

Billing And Claims Specialist

General Statement Of Duties :

The Billing And Claims Specialist is responsible for preparation and delivery of claims to third-party insurance payors and performs follow-up assessments on all discharged patients / residents. The Billing And Claims Specialist will perform other duties necessary to the effective and efficient operation of the department. They will uphold the mission philosophy, and goals of the organization while maintaining strict confidentiality of personnel and patient data and information in the performance of assigned duties.

Essential Functions :

• Responsible for preparing system spreadsheet for accuracy before uploading to the CRS data reporting system.
• Verifying claim forms from billing system to CRS data reporting system before claims are submitted.
• Responsible for creating claims and data entry of TWC / VR for payment.
• Responsible for submission of all mailed claims with appropriate documentation attached.
• Follow up on outstanding insurance claims to ensure timely payment.
• Review and analyze EOBs to identify underpayments, denials and discrepancies.
• Prepare and submit effective appeals for denials or underpayments.
• Responsible for replying to Billing Request Affidavits for patients in Galveston and Lubbock. Complete necessary Affidavits and submit them to the requesting attorney's office accordingly.
• Identify payer trends to minimize potential claim denials.
• Document all follow-up activity and payer communications accurately in the system.
• Monitor aging reports and prioritize high-dollar and time-sensitive claims.
• Maintain current knowledge of payer policies, fee schedules, guidelines and billing requirements.
• Documenting all outgoing mail and reviewing frequently to ensure delivery.
• Operate office equipment such as fax machines, copiers, and phone systems.
• Use of Microsoft Office Suite to create Excel spreadsheets and Word documents, database management, and other applications.
• Discharges duties in accordance with Moody Neuro organizational policy, CARF and other accrediting bodies.
• Other duties as assigned.

Qualifications

Required Knowledge, Skills and Abilities :

Education :

High school diploma, prefer some college.

Experience :

Minimum of two years of experience in medical billing

Demands and Characteristics of Work, Equipment Usage, and Work Environment :

Percentage of Work Time (34-66%) :

Percentage of Work Time (67-100%) :

LIFTING REQUIREMENTS - I :

Individuals in clinical care positions are required to lift a trainee / client without assistance. (1-33%)

Does This Job Require? (1-33%) :

Does This Job Require? (34-66%) :

Exchange of Ideas (67-100%) :