Medical Billing Specialist - Tal Healthcare

Our client, a national company servicing medical across the county and NY is seeking a Medical Billing and Follow-up Specialist.
Responsibilities:

• Creates and manages submission, intervention and resolution of bills, appeals, and grievances both electronically and manually

• Conducts pertinent research, evaluates, responds and completes appeals and other insurance/policy guideline inquiries accurately, timely and in accordance with all established regulatory guidelines.
• Prepares appeal documentation, summaries, correspondence, as well as documents information for tracking/trending data.
• Review denied insurance claims, identify and resolve the issues in order to resubmit.
• Develop strategies to reverse claim denials.
• Manage and organize appeal workflow based on internal and insurance-driven deadlines.
• Researches insurance policy language to determine medical necessity criteria.
• Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research.
• Collaborates with other team members to determine appropriate responses.
• Prepare documentation for submitting bills/grievances/appeals.
• Maintains current knowledge of regulatory billing requirements.
• Monitors and tracks the number of appealed claims.
• Assure timeliness and appropriateness of all appeals according to state, federal, and company guidelines.
• Position can be a hybrid, two or three days in office.

• Prior experience in the creation, submission, and completion of all hospital bills and insurance appeals.
• Office administrative experience and the ability to work independently while effectively researching and maintaining the most current government laws and patterns of insurance denial, etc.
• Familiarity with Commercial Insurance, Medicaid and Medicare claims denials and appeals processing, and knowledge of NCCI guidelines and LCD/NCD Edits for appeals and denials.
• Familiarity with the Tri State Area Payers and Fiscal intermediary necessary

Desired Skills:

• Computer literacy, especially with MS Office
• Knowledge of Medicare and Medicaid rules and regulations.
• Efficient multi-tasking.
• Strong organizational skills
• Ability to prioritize workload based on strict deadlines.
• Attention to detail.
• Effective organization of work assignments.
• Effective written and oral communication.
• Ability to self-motivate and learn quickly.
• Ability to review and understand insurance policy language and guidelines.
• Understand and comply with HIPAA regulations.

Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
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