Billing Specialist

About the Role

Job Description: As a Billing Specialist at MOKSCARE Clinic, you will play a crucial role in the financial operations of our healthcare facility. You will be responsible for accurately and efficiently managing the billing process, ensuring timely reimbursement from insurance providers and patients. Your expertise in medical coding, insurance claims, and financial systems will contribute to the clinic's financial success.

Responsibilities:

Medical Billing:
Review patient charts and medical records to accurately assign appropriate medical codes for diagnoses, procedures, and services rendered.
Prepare and submit electronic and paper claims to insurance companies, ensuring compliance with coding and billing guidelines.
Verify insurance coverage, obtain pre-authorizations, and follow up on outstanding claims to facilitate prompt payment.
Resolve billing discrepancies, denials, and rejections by communicating with insurance companies, patients, and healthcare providers.
Insurance Claims Management:
Monitor and track insurance claims to ensure timely processing and reimbursement.
Investigate and appeal denied or underpaid claims, providing necessary documentation and supporting information.
Follow up on outstanding accounts receivable, including overdue payments and unpaid claims.
Maintain accurate records of claim status, payments, and adjustments.
Patient Billing and Collections:
Generate and send patient invoices for services rendered, including co-pays, deductibles, and outstanding balances.
Provide clear and concise explanations of charges, insurance coverage, and payment options to patients.
Answer patient inquiries regarding billing issues, insurance claims, and payment arrangements.
Collaborate with patients to establish payment plans and facilitate timely resolution of outstanding balances.
Financial Reporting and Analysis:
Generate and analyze financial reports related to billing, collections, and accounts receivable.
Identify trends, issues, and opportunities for process improvement to optimize revenue cycle management.
Collaborate with the finance department to ensure accurate and timely financial data.
Compliance and Documentation:
Ensure compliance with applicable laws, regulations, and industry standards related to medical billing and privacy.
Maintain confidentiality and security of patient information in accordance with HIPAA regulations.
Keep up-to-date with changes in coding guidelines, insurance regulations, and billing practices.
Requirements:

High school diploma or equivalent (additional certification in medical billing and coding is preferred).
Proven experience as a Billing Specialist in a healthcare or medical setting.
In-depth knowledge of medical coding systems (such as CPT, ICD-10) and insurance claim submission processes.
Proficiency in using billing software, electronic health records (EHR), and financial systems.
Strong analytical and problem-solving skills.
Attention to detail and accuracy in coding, billing, and claim submission.
Excellent communication and interpersonal skills.
Ability to handle sensitive and confidential information with discretion.
Knowledge of healthcare billing regulations, including HIPAA compliance.
Strong organizational and time management skills.
Ability to work independently and collaboratively in a fast-paced environment.