Medical Enrollment Specialist and Billing Support
The Medical Billing Enrollment Specialist is responsible for Electronic Data Interchange (EDI) enrollment setup and maintenance for new and established clients. Coordinates and works closely with clients and payers to obtain required information for timely submission of electronic claims. The Medical Billing Enrollment Specialist is also responsible for research, patient account resolution and is a resource and contact for Insurance payers and client concerns. They will assist other Medical Billing Representatives and Specialists.
- Coordinates and processes payor enrollments with client/clearinghouse(s)/payors from start to finish for all EDI products.
- Reviews Provider Setup Form and related forms returned by client to ensure accuracy. Accurately identifies payor ids for payors requested. Sets up client in appropriate sites (e.g. Medicare, Medicaid, GE, Emdeon/Change Healthcare, etc.)
- Ensures timely completion, tracking until approved, and taking any actions needed such as handling rejected agreements, client follow-up. Updates Visonex and clients on agreement status.
- Coordinates with EDI Implementation reps and Visonex team as needed to ensure fastest possible setup and
- Works assigned projects and troubleshoots issues that arise as independently as possible. Effectively uses tools/resources for guidance and researches for solutions.
- Helps the team as a resource and assists with special projects as assigned.
- Import HL7 files of monthly billing charges and lab results into the billing system.
- Verify accuracy of monthly charges in billing system.
- Resolve claims rejections and responds to insurance correspondence.
- Review denials, make appropriate corrections and re-bill claims.
- Follow standard procedures and account documentation guidelines.
- Reviews underpayments, researches and acts to reach account resolution.
- Update insurance information in the billing system as necessary.
- Review worklists/reports/systems to identify opportunities for improvement.
- Maintain a professional work relationship with all clients and office staff.
- Other duties as assigned.
MINIMUM QUALIFICATIONS & SKILLS REQUIRED:
- High school diploma or equivalent.
- 4+ years experience in electronic billing, payor regulations or EDI implementation.
- Minimum of 2 years healthcare revenue cycle experience required.
- Certification in medical billing/coding a plus.
- Must have knowledge of HMO, PPO, Medicare and Medicaid billing guidelines.
- Knowledge of ICD-10, CPT and HCPCS codes, billing practices, medical terminology, code sets and cliam forms preferred.
- Effective verbal and written communication and positive interpersonal skills.
- Excellent organizational skills with the ability to prioritize and handle multiple tasks.
- Attention to detail, critical thinking, problem solving, investigative, and decision-making skills required.
- Ability to use tact and diplomacy with patients and internal customers in all situations.
- Working knowledge of Microsoft Outlook, Word and Excel.
- Maintain knowledge and ability to perform company business within the United States of America, and at international locations designated by the Company.
While performing the duties of this job, the employee is regularly required to sit for up to eight hours. Manual dexterity which allows the individual to use hands to type on a keyboard, use a mouse and write are required, as is the ability to talk and hear. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Send your resume to Visonex Human Resources. If you have any questions contact Visonex at (920) 496-0600 or toll free at (866) 847-6639 to talk to a Human Resources representative.