Surgery Medical Billing Specialist

The Surgery Medical Billing Collections Specialist must be able to work review aged EOBs and resolve denials.

• -Performs full cycle billing and collection functions for OHMG Surgical professional fees
• -Verify patient eligibility, authorization status and primary payer information via CareConnect and Insurance portals prior to claim submission
• -Performs all data entry and charge posting functions for OHMG services as needed
• -Performs all third party follow-up functions for all products and OHMG surgical procedures.
• -Reviews EOBS and Denials. Make corrections as required and resubmit the claim for payments
• -Work on the Athena Work Dashboard / Claim list on a daily basis for all OIC services assigned
• -Performs daily review of Urgent Care provider chart notes to assure that documentation is complete and supportive of submitted charges prior to billing.
• -Provides the correct ICD-100M code to identify the provider's narrative diagnosis
• -Provides the correct HCPCS code to identify medications and supplies
• -Provides the correct CPT code to accurately identify the services performed based on the provider's documentation.
• - Reviews all surgical operative reports and assigns appropriate CPT codes and tCD-10-CM codes for services performed by staff surgeons
• Minimum of three years experience in Medical Billing within a healthcare, hospital, or social assistance setting.
• Demonstrated skills in Medical Collections, with a strong understanding of the collection process in a healthcare context.
• Experience with Ambulatory Surgery procedures and related billing tasks.
• Familiarity with Surgery procedures and associated billing requirements.
• Experience handling Medical Denials, including understanding of common reasons for denials and strategies for appeal.
• Proficiency in Charge Entry tasks, with the ability to accurately input data into billing systems.
• Experience with Medical Appeals, including drafting and submitting detailed appeals to insurance providers.
• Ability to work collaboratively in a team environment, as well as independently when required.
• Strong communication skills, both written and verbal, to effectively liaise with patients, insurance providers, and medical professionals.
• Willingness to stay updated with changes in medical billing regulations and procedures.
• Proven ability to maintain patient confidentiality in accordance with relevant laws and regulations.