Medical Billing Representative (225-827)

A Medical Billing Representative plays a crucial role in the healthcare industry by managing patient insurance claims and ensuring accurate billing practices. This professional is responsible for submitting and following up on claims with insurance companies to receive payment for healthcare services rendered. The ideal candidate will possess a strong understanding of medical billing processes, insurance procedures, and the ability to navigate electronic health records systems efficiently. Being detail-oriented and possessing strong communication and organizational skills are essential attributes for success in this role. The Medical Billing Representative must also ensure compliance with all federal and state laws, as well as establish and maintain positive relationships with all stakeholders involved.

Responsibilities

• Prepare and submit clean claims to various insurance companies either electronically or via paper.
• Review and verify the accuracy and completeness of patient insurance information.
• Communicate effectively with insurance representatives and healthcare providers to resolve discrepancies.
• Follow up on unpaid or denied claims, and prepare appeal letters if necessary.
• Analyze and respond to questions from patients, insurance companies, and physicians efficiently.
• Post payments and reconcile transactions in patient accounts, ensuring records are accurate.
• Maintain strict confidentiality of patient records and financial information at all times.
• Ensure billing operations comply with HIPAA regulations and other relevant laws.
• Develop and maintain physician practice relationships for seamless billing procedures.
• Generate and distribute monthly aging reports for outstanding accounts receivables.
• Provide training and support to newly hired billing representatives when required.
• Stay up to date with changes in insurance and billing regulations to ensure compliance.

Requirements

• High school diploma or equivalent; associates degree preferred in a related field.
• Minimum of two years’ experience in medical billing or a related role.
• Proficiency in medical billing software and electronic health records systems is required.
• Strong knowledge of CPT, ICD-10, and HCPCS coding systems mandatory.
• Excellent attention to detail and organizational skills are critical for success.
• Ability to communicate effectively with diverse stakeholders including patients and insurers.
• Familiarity with state and federal billing regulations, including HIPAA compliance.