Billing Specialist

• - Reviews claims that have been adjudicated by Medicare, Medicaid, and Commercial carriers for appropriate billing.
• - Addresses denied claims, claims pended for medical necessity, and claims pending for supporting documentation and/or medical records by working with various teams such as clinic staff, registration staff, and coding staff to complete appeals.
• - Extracts information regarding patient treatment from medical records and works closely with coding staff to compose individualized appeal letters.
• - Identifies payor specific patterns or trends regarding denials and reports to management for communication to Medical Departments and Administrators.
• - Makes the necessary recommendations regarding billing and edit creation to reduce denials.
• - Remains current in all payor specific guidelines.
• - Utilizes various collection processes such as appeals or collection notices by mail, electronic correspondence, and telephone communication with payor representatives.
• - Performs all other duties as assigned.

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