MEDICAL BILLING SPECIALIST

SUMMARY:

The Medical Billing Specialist is responsible for verifying documentation prior to processing and for coding medical and billing information. This position is governed by state and federal laws and institution policy.

TYPICAL FUNCTIONS:

Posts medical charges and payments received.

Reviews documentation and physician dictation. Verifies coding of diagnosis and related services and charges and keys information into database.

Audits accounts for coding errors and makes corrections.

Performs reconciliation, end of day, and other required reports.

Transmits electronic claims and prints required forms.

Reviews and reconciles denials.

Verifies insurance, Medicaid information, and other pertinent data.

Settles payment arrangements for patient accounts and handles collection accounts.

Coordinates refund reports.

Performs duties related to file maintenance that may include archiving and scanning.

Performs other duties as assigned.

KNOWLEDGE, ABILITIES, AND SKILLS:

Knowledge of applicable laws and regulations and medical terminology. Knowledge of computers and software application programs. Knowledge of medical terminology and coding. Knowledge of customer service and basic accounting principles. Ability to perform accurate data entry and manipulate data to generate reports and documents. Ability to compose, proofread, and edit correspondence, reports, and other documents.

MINIMUM EDUCATION AND/OR EXPERIENCE:

The formal education equivalent of a high school diploma; plus three years of experience in healthcare or insurance billing or a related field.

Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management.

OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.