Medical Billing Specialist

Position Summary: 

We are actively seeking experienced and highly motivated Medical Billing Specialist (AR and Collections) to join our dynamic team. The successful candidate will play a crucial role in managing our collection processes for TDD services. The tasks include contract analysis, reimbursement, denial management, appeals, and resolving billing-related issues with insurance companies or other responsible parties for services rendered. The ideal candidate should possess in-depth knowledge of billing and collection practices and have a strong track record in resolving complex financial situations. 

Job Details: 

Medical Billing Specialist (AR and Collections) 

• Work from home 
• Monday to Friday | 9 PM to 6 AM (Manila Time) 
• US Holidays & PH Regular Holidays 

Responsibilities: 

• Recognize and support patients’ rights and responsibilities in the performance of job duties, while respecting their privacy and confidentiality. 

• Follow up on submitted invoices to ensure prompt and timely payment, escalating issues as necessary. 

• Evaluate payments/denials received for correctness and ensure they are applied accordingly. 

• Identify bad debt write-offs and A/R adjustments. Initiate write-offs and adjustments in accordance with established policies and procedures. 

• Detect any overpayments and/or duplicate payments and investigate and resolve accordingly. 

• Process refund requests, in accordance with policies and procedures. 

• Maintain contact with other departments to obtain the patient or insurance information needed for claim payment. 

• Understand all procedures within regulatory mandates. 

• Ensure that the collection operations are conducted in a manner that is consistent with overall department protocol and follows Federal, State, and payer regulation, guidelines, and requirements. 

• Make calls to troubleshoot payment discrepancies and establish resolution. 

• Document, in detail, phone calls, phone numbers, persons spoken to, and call details on a consistent basis. 

• Consistently look for areas to maximize claim reimbursement. 

• Resolve issues that caused a denial within 5 days of receipt of denial. 

• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations. 

• Understand NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies. 

• Maintain a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes. 

• Share knowledge gained with other staff members and work as a team member. 

• Interact with others in a positive, respectful, and considerate manner. 

• Perform other job-related duties as assigned. 

Qualifications: 

• A high school diploma or general education degree (GED) equivalent. 

• At least 3 years of medical billing and collections experience. 

• Home Infusion experience, hospital or chemotherapy experience is required. 

• Experience in calculating drug units, Intrathecal Pain Management is a plus. 

• Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations. 

• Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders. 

• Strong work ethic with personal qualities of integrity and credibility. 

• Self-directed, detail-oriented, conscientious, organized, and able to follow through. 

• Ability to deal in an organized manner with problems involving multiple variables within the scope of the position. 

• Tolerance of frequent interruptions and distractions from staff and other internal support teams. 

• Proficiency in Microsoft Office, including Outlook, Word, and Excel.