Job Description

Job Description

Exciting Medical Billing Specialist Opportunity! Are you ready to take your career to the next level? At Converge Medical Technology, we provide game-changing technology with empowering personalized patient services as part of our supervised physical therapy program. The Medical Billing Specialist role maintains the financial integrity of CMT Billing and Accounts Receivables by actively and reviewing and carrying out essential Billing and Collections functions. The ideal candidate must have experience with Workers' Compensation claims, prior authorizations and comfortable working with Adjusters, Nurse Case Managers, and Claims reps.

Key Responsibilities

• Ensures accurate and timely billing of HCFA 1500 claims.
• Understands CPT, ICD10 and HCPC coding.
• Make outbound telephone calls to insurance companies for claims resolution.
• Follows existing billing/collection protocols to ensure accurate and timely reimbursement.
• Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.).
• Collaborates/coordinates with Utilization Review for prior authorization/medical necessity documentation.
• Appeals denied claims, front in authorizations as well as back end denials.
• Calls insurance companies and uses carrier websites in collection efforts.
• Reviews accounts receivable accounts to ensure accurate reimbursement and Identify payor issues affecting payment delays.
• Responsible for the DME business aspects of arranging care regarding insurance verification, coverage limits and identifying and qualifying medical documentation requirements as applicable.
• Manage incoming referrals and maintain track of all inquiries and responses provided.
• Utilize Salesforce to conduct day-to-day business responsibilities according to standard operating procedures.
• Responsible for incoming and outgoing, high volume telephone calls acting as liaison for insurance companies and sales reps to process prior authorizations, appeals and updates.
• Research required information using available resources to complete referral submissions and updates.
• Abide by all HIPAA, Confidentiality and Privacy laws

Qualifications

• High School diploma or equivalent required and 2-5 years of healthcare billing and collections/financial experience preferred.
• Working knowledge of CPT, ICD-10 coding.
• Must be a certified medical coder and have Worker's Compensation experience
• DME preferred but not required.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
• Ability to calculate figures and amounts (such as discounts, interest, commissions, proportions, percentages) and apply concepts of basic algebra and geometry.
• Ability to define problems, collect data, establish facts, and draw valid conclusions including interpreting an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Location: In Person in Austin, TX

Pay Range: $22- $24/hr

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