The Senior Billing Specialist will be responsible for helping to improve bottom line revenue by managing high volume medical claim correction and ensure clean claim submission to our contracted health plans. The Senior Billing Specialist will also help refute denied claims through the accurate review, correction, and resubmission medical claims. The ability to reach out to, collaborate, and influence insurance payers, internal departments, and occasionally patients is required of this role. Lastly, The Senior Billing Specialist will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.
The Senior Billing Specialist must have a clear understanding of the intricacies of medical billing encountered in such areas like ambulatory care, physician/provider offices, or professional billing settings. In addition, a clear understanding of CPT, ICD-9/10, CMS 1500 claim formatting, as well as, familiarity with Electronic Data Interchange (EDI) transmission, Electronic Health Record or encounter charge creation is key to success in this position. Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data is important.
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