Travel Billing Specialist Job Family – Full Time – Medicaid Travel Office

JOB SUMMARY: Under normal supervision, prepare and process eligible billing claims for travel services. Reviews and adjusts accounts to ensure accurate and thorough processing of these claims.

REPRESENTATIVE DUTIES

Ensure high quality, timely completion of work, accurate data entry, efficient processes and positive working relationships among the supervised employees to include internal and external patient/ clients.

Requires strong analytical and business skills to set up and manage all aspects of billing systems according to Medicare, Medicaid, and Private Insurance.

Processes and prepares business and government forms.

Manages all electronic claims entry and processes.

Investigates all denied claims and edits for re-submission.

Performs quality assurance testing on all EMR programs to ensure accurate processing and compilation of data for required payers.

Assure timely billing and collections, achieve and maintain a collection rate of less than 30% with A/R of 60 days or greater.

Research billing and coding requirements for new services as directed by Financial Operations Manager.

Maintain strong working knowledge of coding and changes in coding and modifiers.

Consult with Providers to resolve or clarify codes and diagnoses with conflicting, missing or unclear information.

Create and edit templates and codes in the EMR system as directed by Providers.

Monitor and order CPT/ICD-10 coding books for clinic staff.

Maintain Electronic Data interchange (EDI) systems for services.

Review, prepare and submit claims to all 3rd party payers. Identify appropriateness of billable charges. Determine Primary Payer when more than one is listed. Provide documentation and /or reports with claims when necessary.

Identify every billable expense and increase revenue in the most efficient and timely manner by preparing and submitting insurance claims and reviewing and adjusting accounts to ensure accurate and timely payments.

Prepare monthly aging reports.

Maintaining strong knowledge of referral and claim processing software, master files and interface conversion tables.

Performs other duties as assigned.

Required Skills
KNOWLEDGE and SKILLS

Knowledge of electronic medical record systems.

Knowledge of ICD-10 and CPT coding.

Knowledge of medical insurance process.

Knowledge of alternative health resources.

Knowledge of customer service concepts and practice.

Knowledge of basic medical terminology and clinic systems.

Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966.

Knowledge of state, federal, and tribal health care programs.

Knowledge of state, federal and public/private insurance, including Medicaid/Medicare.

Skill in working independently.

Skill in grammar, spelling, sentence structure and effective business letter writing.

Skill in operating office equipment, including copiers and fax machines.

Skill in interpreting state, federal, and public/private insurance financing.

Skill in establishing and maintaining cooperative working relationships with others.

Skill in operating a personal computer utilizing a variety of software applications.

Required Experience
MINIMUM EDUCATION QUALIFICATION

Level I: A high school diploma or GED equivalent.

Level II: A high school diploma or GED equivalent.

Level III: An Associate’s Degree in Business, Finance, Accounting, or related field. Progressively responsible accounting technician, medical billing, or related work experience may be substituted on a year-for-year basis for college education.

MINIMUM EXPERIENCE QUALIFICATION

Level I

Non-supervisory – One (1) year experience in the medical office experience involving medical billing.

Level II

Non-supervisory – Three (3) years of accounting, billing, insurance, medical claims care office or related experience. An equivalent combination of relevant education and/or training may be substituted for experience.

Level III

Non-supervisory – Four (4) years of accounting, billing, insurance, medical claims care office or related experience. An equivalent combination of relevant education and/or training may be substituted for experience

MINIMUM PHYSICAL REQUIREMENTS

Requires the ability to sit for long periods of time and work under emotionally stressful conditions. May occasionally be exposed to infectious diseases. May occasionally encounter verbal abuse from customers or family members. ANMC is not a latex free environment. Therefore, some latex exposure can be expected.