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XRHealth Medical Billing Specialist in Brookline, Massachusetts

Principle Duties and Responsibilities:

  • Be the main point of contact for our third-party billing company.

  • Manage self-pay patients including collecting charges and issuing refunds when applicable.

  • Responsible for obtaining and maintaining prior authorizations per patient’s insurance plan requirements

  • Collect, verify, and document all patient’s information, including insurance and eligibility information to manage their medical records in the EHR

  • Manage the clinic schedule including follow up on cancellation and no-show

  • Submit accurate/clean claims to insurance carriers for payment, including coordinating benefits with multiple insurance carriers.

  • Review claim payments for proper reimbursements; appealing underpaid or denied claims as needed.

  • Telephone, mail, and email communication with insurance companies regarding open or denied claims.

  • Review patient insurance, billing & collections, and data processing to ensure accurate patient billing and efficient account collection.

  • Review the coding work queues accessing the accuracy of CPT and ICD-10 coding to ensure compliance, correcting issues & releasing bills for processing.

  • Establish and implement billing policies and procedures, as well as research, recommend and implement best business practices.

  • Maintain up-to-date expertise and knowledge of healthcare billing laws, rules, regulations and developments to inform business decisions and assure compliance with applicable rules & regulations.

  • Act as a liaison between the billing staff and Clinicians / Providers regarding billing issues and education.

Desired Qualifications:

  • Bachelor’s Degree Preferred

  • Excellent customer service and communication skills

  • 2-3 years of experience medical billing experience needed; experience in an outpatient clinic strongly desired, rehabilitation and telehealth is a plus.

  • Knowledge with CPT & ICD-10 coding requirements.

  • Extensive knowledge of relevant billing regulations and insurance regulations, reimbursement systems.

  • Ability to prioritize and manage multiple responsibilities, manage projects, demonstrate leadership and cultivate strong working relationships with Senior Management and others throughout the organization.

  • Ability to review clinician documentation & assist them to meet requirements

  • Working knowledge of Kareo (HER/Billing) a plus, EHR/EMR experience required

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