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Portland, ME 04104
The Billing Specialist processes, appeals and follows up on claims to all payers, including government, commercial, worker’s compensation and liability payers. The Specialist must gain a familiarity with many payer policies and procedures, including rules for claims appeals, rules regarding the use of ABNs, payer website navigation, coordination of benefits, and filing limits to obtain payment for services rendered from the appropriate party The Billing Specialist will also answer all incoming calls from patients for a host of reasons including but not limited to; statement disputes, insurance questions, making payments, financial assistance, and patient quality issues. In addition, the Billing Specialist must also apply critical thinking skills and judgment to coordinate resolution of patient questions with coding, providers, PSRs and clinical staff on a regular basis.
Prioritize workload to align with department metrics and goals
Follow our current AR aging workflow in order to minimize loss of revenue for the delivery system
Answer incoming patient calls and address patient issues and concerns in a timely manner
Research and resolve insurance overpayments
Research and process patient credit balances
Work with individual payers to resolve issues affecting claims processing
Process and respond when needed to patient and payer correspondence
Act as a resource to the sites which are assigned, including occasionally traveling to the site to help with PSR education and training
Assist patients with issues related to accounts in collections and accounts from legacy systems
Research & resolve balances that are unable to be applied against a patient’s account by athena
Appeal denials and send corrected claims to payers
Correctly classify payer Incentive Payments according to appropriate MPHC contracts
Maintain positive relationships through communication and commitment to the team and their work
Learn new workflows and demonstrate flexibility when needed to help other teams or work on special projects identified by management
Work closely with the coding team to maximize revenue and decrease the number of rejected claims
High School Diploma or GED
2+ years clerical or related experience
Data Entry experience
Primary care claims experience preferred
Knowledge of medical terminology, ICD-9 & ICD-10, CPT and HCPCS coding preferred
Must be proficient in use of computers, terminals and keyboards
Experience with MS Office products preferred
Demonstrates an understanding of and alignment with Martin’s Point Values.
Ability to maintain confidentiality of healthcare data (HIPAA Compliance)
Capacity to be cross trained to new payer types as business indicates
Demonstrates significant change agility
Ability to demonstrate MPHC Core Competencies
Excellent organizational skills and attention to detail
We are an equal opportunity/affirmative action employer.