Job Summary:

The Medical Billing/Insurance Specialist oversees operations of insurance and patient collection functions, analyzes data, secure authorizations for surgical patients and maintains integrity of multiple computer applications.

DUTIES, RESPONSIBILITIES AND PERFORMANCE CRITERIA: 

The essential functions include, but are not limited to, the duties listed below. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is a logical assignment to the position.

• Answer incoming calls and assist patients with their billing inquiries

• Collect on patient balances and/or establish payment plans

• Review weekly schedules for patients with upcoming appointments, contact patient and communicate to front desk of previous balance and/or credits

• Liaison between patients, care centers, and customer service agents in resolving insurance or patient account issues to completion.

• Responsible for obtaining accurate surgical benefit information and capable of providing accurate surgical/ procedure quotes

• Obtain required precertification for surgical/procedures and communicate back to procedure schedulers when additional information is needed. 

• Able to investigate and appeal claims if needed

• Perform responsibilities in ModMed, including but not limited to file maintenance, and tasking in the platforms.

• Capable of working independently with minimal supervision required.

• Willingly accepts other duties as required.

Education and Experience:

• High School Diploma or general equivalency diploma (GED),

• Capable of reading and understanding insurance EOBs, denial codes, and medical/insurance terminology 

• Experience with insurance verification of benefits as well as precertification, predetermination and referrals a must. 

• Knowledge of EMA/ModMed software strongly preferred

• Two or more years of recent experience working as a Medical Billing Specialist or comparable role