Medical Billing Specialist


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Man and woman working remotely from their computers. Image text: Full-Time/Remote Medical Billling Specialist

Hello, We Are ruralMED!

Join our mission of supporting rural healthcare through collaboration focused on strategically tailored services, effective leadership, and industry-specific expertise.

As a Medical Billing Specialist, you play a vital role in supporting rural healthcare facilities and the communities they serve. You are responsible for planning, organizing, and implementing workflows and processes for rural medical billing. You utilize expertise in commercial and governmental payor policies and regulations to perform initial billing, follow-up, and denial management to ensure accuracy and compliance.

How This Role Makes an Impact:

  • Experience the rewarding satisfaction of supporting rural healthcare facilities to achieve excellence and thrive in changing environments
  • Work alongside a team of dedicated and driven experts passionate about supporting rural healthcare with revenue cycle expertise
  • Apply problem-solving and critical thinking skills, empowering ownership and ingenuity in the development of processes and workflows to enhance efficiency and accuracy
  • Ensure facilities achieve accurate and compliant billing and provide the highest quality of care to patients and communities.

What It’s Like Working at ruralMED:

  • An elite and highly skilled team driven by delivering superior results and striving for new levels of excellence
  • Flexibility and autonomy with a company that understands the true value and benefits of work-life balance
  • Personal and professional growth opportunities are encouraged
  • Employee engagement is used as a valuable tool for achieving excellence
  • We operate by our Core Values:
    • It Begins With You: Own it.
    • Pave the Way. Never Settle.
    • Be Thoughtful. Be Transparent. Be Extraordinary.
    • Work Fearlessly. Celebrate the Wins.
    • Capitalize Our Strengths. Achieve Excellence.
  • Learn more about our team: https://ruralrevcycle.com/join-our-team/

How to Succeed in this Role:

  • Highly motivated, analytical, critical thinker, solution focused, self-disciplined and adaptable
  • Three (3) years of rural health (CAH & RHC) medical billing experience, five (5) years preferred
  • Ability to take direction and work independently
  • Strong communication and collaboration skills
  • Effective and efficient navigation of multiple EHR systems and payor portals

Stand Out and Get Bonus Points!

  • Experience with Cerner Community Works, Meditech, Allscripts, or CPSI
  • Advanced skills with one or more Microsoft Office programs
  • Ability to quickly learn new processes, methods, technology systems, and platforms


Title: Medical Billing Specialist

Department: Revenue Cycle

Supervises: NA

Status: Full-Time


Position Summary:

The Revenue Cycle Specialist will be responsible for performing all aspects of insurance billing and follow-up functions within their assigned account inventory. They will ensure the timely and accurate submission of claims, follow-up on denied, underpaid, and aging claims, process refund requests, and resolve patient billing inquiries. Furthermore, they will ensure maximum reimbursement for services provided by utilizing sound knowledge of insurance rules and regulations, best practice workflows, and the use of multiple software systems. Compliance with rules and regulations of all applicable federal, state and local laws as well as ruralMED policies is a condition of employment.

Locations: Currently registered in Nebraska, Kansas, or Missouri


Qualifications:

Education and/or Experience:

• High School Diploma is required.
• One to three years experience in billing, follow-up, or registration within a hospital or clinic setting is preferred.
• One to Three (3) years of rural health (CAH & RHC) medical billing experience preferred.


General Requirements/Job Duties:

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and / or ability required:

Charge Entry:

  • Receive and review charge entry data from practice sites.
  • Identify and investigate incomplete or missing charges.

 

Billing:

  • Manages and maintains assigned account inventory, completes required reports, and resolves high priority and aged inventory in a timely manner.
  • Processes electronic and paper claims in a timely and accurate manner. Ensures edits to electronic claims meet and satisfy billing compliance guidelines for electronic submission.
  • Resolves clearinghouse and payer rejections daily.
  • Verifies claims adjudication by utilizing appropriate resources and applications.
  • Performs immediate follow-up on underpaid or unpaid insurance claims. Researches, identifies and rectifies any circumstances affecting delayed payment of accounts and takes steps to get claim paid utilizing websites, phone calls to the payers, and/or internal inquiry.
  • Resolves issues holding up timely claim payment, including requests for medical records, coordination of benefit issues, or requests for other information, by coordinating with the responsible department.
  • Resolves denied claims utilizing the payer’s designated reconsideration and appeal processes.
  • Reviews remaining balances on accounts after insurance has paid to ensure the account was processed appropriately and performs the next appropriate action.
  • Resolves overpaid accounts by performing payment review to determine if posting corrections are required or/and a refund is due to the insurance company.
  • Processes incoming correspondence from insurance companies, and performs proper action utilizing internal and external resources.
  • Maintains an account aging process for tracking accounts approaching 30 days past billing date.
  • Processes adjustments or corrections to patient account(s) according to policy guidelines.
  • Receives and resolves inquiries regarding accounts, either in-person, by phone or written correspondence from patients, family members, third-party payers, physicians, etc
  • Accurately and thoroughly documents all actions performed on an account in the appropriate area of the EHR system.
  • Initiates telephone or letter contact to patients to obtain additional information as needed.
  • Communicates issues to management, including payer, system, or escalated account issues. Identifies denial trends and provide suggestions for resolution.

 

Self-Pay:

  • Reduces outstanding self-pay accounts receivable by following self-pay policies and procedures to increase cash collections and reduce bad debt.
  • Make calls to the guarantor/financially responsible parties to follow-up on unpaid self-pay balances.
  • Obtains updated demographic and/or insurance information and verifies new insurance coverage prior to rebilling charges.
  • Accurately and clearly document all interactions with patients or insurance representatives.
  • Assigns accounts to appropriate third-party bad debt collections vendor once internal efforts have been exhausted.

 

Cash Posting:

  • Post payments and adjustments to patient accounts from all insurance payers as well as patient payments.
  • Import all electronic payment files into current billing system from multiple sources.
  • Review all remittance advices for accuracy to identify errors or questionable data.
  • Research and resolve unapplied/unidentified cash receipts.
  • Reconciles payments and shortages for all batches.
  • Sort & distribute any correspondence from the lockbox to the assigned collector.
  • Scan any items as backup as necessary

 

Other:

  • Maintains current knowledge of billing and reimbursement rules as designated by the Centers of Medicare and Medicaid Services (CMS), Medicaid Managed Care, and other payers.
  • Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.
  • Communicates issues to management, including payer, system, or escalated account issues. Identifies denial trends and provide suggestions for resolution.
  • Participates in department meetings, in-service programs, and continuing education programs.
  • Maintains a professional attitude with patients, visitors, physicians, office staff and hospital personnel. Assures confidentiality of patient information, maintaining compliance with policies and procedures.
  • Performs other duties as assigned.


Required Knowledge, Skills and Abilities:

• Experience with Cerner Community Works or Meditech preferred
• Knowledge of medical terminology and/or insurance terminology is required.
• Proficient with Microsoft Office


Security/Access:

• Remote work is expected 100% of the time unless otherwise agreed upon.
• Will have access to confidential information abiding by the organizations privacy policies and regulations concerning this information.


Equipment Used:

• General office equipment to include: fax, copier, computer, printer, etc.
• Telephone


Patient Age Groups Served:

None.


Essential Work Environment & Physical Requirements:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.