Billing Specialist

Billing Specialist

Department: Appalachian Institute for Health and Wellness - 273600

Minimum Qualifications

Graduation from high school and minimum of two years of related office experience with billing and credentialing; or an equivalent combination of education and experience.

Diplomas or degrees must be received from appropriately accredited institutions.

License/Certification Required

Essential Job Functions

• To execute all billing and credentialing for all AppWell clinic facilities.
• Claims Submission: Prepare, review, and transmit claims to insurance companies (commercial and government) for reimbursement.
• Payment posting: Post all payments received via mail, ACHs and or Virtual payments. Front desk staff will post all in-person payments.
• Revenue Cycle Management: Monitor claim status, follow up on unpaid claims, and appeal denied claims to ensure timely payment.
• Patient Billing: Calculate patient responsibility, send patient statements, and handle inquiries about bills.
• Compliance: Adhere to HIPAA regulations to maintain patient confidentiality and comply with all legal/payer requirements.
• Provide front desk back up support to the LLHS Clinic Front Desk as needed.
• Be available to train student interns, graduate assistants, and student employees as appropriate. Serve as a mentor modeling professional behavior.
• Execute Insurance provider enrollment processes and set up.
• Execute Initial set up and maintenance of credentialing for all affiliated providers.
• Update and maintain all CAQH Provider Profiles.
• Proper use and assignment of billing codes.
• Knowledge of HIPAA regulations.
• Stay up to date on appropriate billing codes and procedures.
• Balance end of day according to clinic policies and procedures. Track payments from all sources including Touchnet, Clover, Zelis, Availity, WayStar, (and others) as well as Student Accounts.
• Obtain prior authorizations as needed for allied health provider services.

Knowledge, Skills, & Abilities Required for this Position

Preferred Qualifications

Coding Expertise: Proficiency in ICD-10-CM, CPT, and HCPCS Level II coding systems.

Technical Proficiency: Familiarity with Electronic Health Records (EHR) and medical billing software.

Attention to Detail: Ability to spot inaccuracies in medical records and ensure precision in code application.

Communication: Strong verbal and written skills for interacting with providers and patients regarding billing.

Medical Knowledge: Understanding of medical terminology, anatomy, and physiology.

Work Schedule/Hours: Monday-Friday 8:00am-5:00pm

Anticipated Hiring Range:

Closing Date: