Express Employment Professionals is currently seeking a Medical Billing Specialist for a clinic in Morgantown.   This position is responsible for submitting medical insurance claims with commercial insurance carriers, Medicare and Medicaid, electronically, when possible, and by paper; posts insurance and patient payments to patients’ accounts. Verifies submitted charges with providers, if necessary, and assists patients in understanding charges and payments to their accounts. Perform denial management and follow-up on unpaid claims for resolution.

Essential Duties and Responsibilities:

• Reviews daily charges/previous days’ appointments and creates/submits all claims. Verifies diagnosis, provider number, patient ID number, verifying the correct charges where processed, based on the encounter types. Submits primary and secondary insurance claims within 48 hours of rendering service or posting of primary remit.
• Reviews code assignments and assigns modifiers when appropriate for clean claim filing. Queries providers as needed to ensure accuracy.
• Accurately posts payments from all payers; proof, balance, close payment entry and file with the day’s transaction reports. Reconciles all deposits and EFTs with EOB remit files, both electronically and on paper.
• Researches all claims paid in error or denied, defines denial and codes appropriately based on standard HIPAA reason and remark codes, and reports trends or unusual denials to the Director. Demonstrates an understanding of payer fee schedules and encounter rates to monitor payment rate accuracy.
• Files appeals timely and/or manages denials online with payers to ensure payment received. Corrects and re-submits claims only when needed; conducts follow up in a timely manner with insurance carriers on denied claims and when necessary to understand denial reason(s) and/or corrective action needed.
• Performs accounts receivable (A/R) follow-up on all unpaid claims at intervals set forth in performance standards to ensure timely resolution. Utilizes payer websites, when available, to check claim status and/or to request reprocessing of claims. Assists patients in understanding charges and payments to their accounts, by phone or in person.
• Assists with eligibility verification electronically or by phone with fiscal agencies to assure claim payments.

Education and Experience:

A high school diploma is required, additional education/training desirable, and at least three years related experience and training in medical insurance claims filing is preferred, or equivalent, preferably in a financial-medical setting, or a combination of education and experience in financial-medical setting.

Compensation for this role will be based on experience up to $18.00 hourly. For immediate consideration please call Express at (304) 381-4466