Position Summary

The Medical Billing Specialist I is responsible for processes and resolving issues related to medical billing within TPMG and their assigned office specifically. This position also assists with accounting and customer service areas when needed within the office.

Major Duties and Responsibilities

• Balance money with Front Office Batch and verify Phreesia totals/ compared to fee slips.
• Back up- Prepare deposit and complete spreadsheet for the Accounting Department.
• Check for Provider Assessment Forms (PAF) fee tickets for Humana insured patients.
• Attach Lab Requisitions to fee tickets.
• Drop charges from fee tickets and post money.
• Prepare fee tickets and do charges for Home Health Certifications and Nursing Home charges.
• Work in conjunction with Clinical Care Coordinator to make sure proper coding/billing for TCM (Verify phone calls documented and change appt. status to TCM). Codes and keeps track of CCM charges.
• Work EHR Pending reports for each doctor.
• Verify Kept Appointments without Charges (KAWOC) report is completed in required timeframe.
• Check AR Report (Unapplied amounts).
• Work Tasks Advisor for denials and correct or query doctor.
• Check daily tasks in Electronic Health Record (EHR) Inbox.
• Query doctor for info required by Lab Corp.
• Reconcile urine slips with charges.
• Reconcile Lab Draw Report.
• Run daily edits, doctor reports and emails.
• Back up - Email deposit register to the Accounting Department.
• Responsible for posting batches.
• Responsible for daily coding of office encounters.
• Responsible for coding hospital and offsite encounters in a reasonable timeframe.
• Completing ICD-10 and CPT coding assignments based off written diagnosis.
• Reconciling collections taken at time of service and applying to encounters.
• Working accounts receivable and denials with Central Billing Office.
• Educate staff/physicians regarding coding errors and resolutions (includes staff errors).
• Other duties as assigned.

Knowledge, Skills and Abilities

• 
  Knowledge of computer systems.
• Knowledge of basic arithmetic to make calculations, balance and reconcile figures, and make changes accurately.
• Skilled in providing excellent customer service.
• Skilled in verbal and written communication.
• Ability to work scheduled hours as defined in the job offer.
• Ability to read, analyze, and interpret insurance information, financial reports, and legal documents.
• Ability to work independently.

Education / Training / Requirements

• High School Diploma/GED.
• Six to twelve months related experience/training.

Physical Demands

• Ability to lift or move equipment.
• Ability to stand and walk for periods of time.
• Ability to sit for extended periods of time.
• Ability to enter data into a computer via a keyboard.
• Ability to occasionally reach, bend, stoop and lift up to 30 lbs. *
• Ability to grasp and hold up to 30 lbs.*
• Ability to occasionally squat and lean over.
• Ability to hear normal voice level communications in person or through the telephone.
• Ability to speak clearly and understandably.
• Basic vision, corrected.
• Ability to see and understand data on a computer screen.

Success Factors

• 
  Alignment with Company Mission and Core Values
• Excellent Time Management/Organized
• Open Communication/Positive
• Goal Driven
• Excellent Customer Service
• Juggles Multiple Priorities
• Accuracy and Attention to Detail

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All statements are essential functions of the position unless identified as non-essential by an asterisk (*).