Billing Specialist

About us:

HEART. It is the driving force of our commitment to serving others with empathy, respect, and dignity. CareMax, is committed to providing the best that medicine has to offer with quality healthcare for those who need it most, our seniors. Join our team and experience it for yourself. We are Health with Heart.

About you:

Under the leadership of the Billing & Coding Manager, the Billing and Revenue Specialist position is responsible for processing medical claims & insurance payments/adjustments and maintaining patient billing records in various health care settings. The Billing and Revenue Specialist carry many different responsibilities, which include examining the claims reviewing from patient demographics, verify insurance eligibility, also is responsible for detecting any coding errors or performing any modifications needed, Reviewing the records using medical coding procedures. In the office, communication with other medical staff members and health insurance providers often occur.

Essential Responsibilities:

• Assists in the processing of all commercial insurance claims and Medicaid/Medicare claims.
• Researches all information needed to complete billing process including getting charge information from physicians
• Submission and verification of electronic insurance claims as well as production of, and mailing of paper claims along with the necessary supporting documents.
• Posting and balancing electronic and paper payments received as well as processing refunds and updating patient records accordingly.
• Follows-up with insurance companies and ensures claims are paid/processed.
• Working the aging accounts receivables report to follow up on past due claims. Resubmits insurance claims that have received no response, are not on file or need corrections. Works with other staff to follow-up on accounts until zero balance.
• Coordination of patient account collection agency activity.
• Assists error resolution.
• Maintains required billing records, reports, files in an organized fashion.
• Answers telephone, screens call, takes messages, and provides information.
• Keeps current with healthcare trends, practices, education and certification.
• Provides coding guidance and insurance verification support to other staff members.
• Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
• Data entry of patient demographics and input charges accordingly, work rejections from clearing house. 
• Various billing and collections functions to ensure accurate and timely claim processing
• General knowledge of ICD-10 and CPT codes
• Insurance follow-up and collection for patient visits.
• Review E.O.B.’s and Respond to Denials.
• Conduct duties in a professional and timely fashion
• Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA.
• Claims management and evaluation of payments, denials, and appeals
•  Production of end-of-month financial reports for managerial review.

Qualifications/Experience:

• Minimum 1 years of Billing and Coding Department medical coding experience with acquired progressive responsibility.
• Strong organizational skills and high attention to detail
• Strong collaboration and relationship building skills
• Proficient knowledge of computers and typical production software (e.g., MS Office, Outlook, Word, Excel, PowerPoint, etc.).
• Experience with Patient Financial Systems and Electronic Medical Records
• Good communication skills
• Proficient in official coding guidelines, ICD-10CM, CPT-4 and HCPCS
• Ability to learn new tasks and concepts
• Maintains strictest confidentiality

Come join the CareMax family and be part of Health with Heart. Help us continue to change lives every day!

CareMax provides equal employment opportunity to all applicants and employees. No person is to be discriminated against in any aspect of the employment relationship due to race, religion, color, sex, age, national origin, disability status, genetics, citizenship status, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws