The support role is expected to assist with medical cases, as well as coordinate document storage, data integrity and data transfer
processes. The Healthcare Billing Specialist role is required to know the membership types, current guidelines and any department
policies to ensure consistent business practices. The Healthcare Billing Specialist role is expected to comply with all HIPAA and
- Review and determine eligibility for member cases ( appeals, reimbursements, maternity, advanced opinion).
- Ensure medical needs are mapped correctly to the provider and member. Map manually if needed.
- Ensure that all medical needs are being tracked on the files when importing or exporting data to carriers or vendors.
- Ensure all records are reviewed, tasks are completed, and open issues are resolved for medical review.
- Proactively communicate potential issues to management to allow for timely resolution.
- Locate and correct data entry errors or report them to supervisors.
- Compile, sort, and verify the accuracy of data before it is entered.
- Compare data with source documents, or re-enter data in verification format to detect errors.
- Work on various projects to ensure member information and medical need information is accurate and up to date.
- Provide support with other tasks as necessary, which may be assigned by management.
- Critical thinking and problem-solving skills
- Self-motivated, goal-oriented individual
- Excellent written, verbal, and interpersonal communication skills
- Work independently and in a team environment
- Strong computer skills and working knowledge of Microsoft Outlook
- Ability to comprehend medical records at a basic level
- Experience with medical policies and procedures, HIPAA, claims processing required
- Healthcare experience required
- High School Diploma is required