Job Description

Neolytix is a multi-line Management Service Organization (MSO) providing support to the smaller healthcare providers and practices so they can remain competitive in our Healthcare system. Together with Practice Tech Solutions (digital division), we provide end-to-end nonclinical services to healthcare providers.

Medical Billing Specialist is responsible for Posting medical charges, payments, and journal entries to patient accounts in a timely and accurate manner.

• Work directly with the insurance company, healthcare provider, and the patient to get a claim processed and paid.
• Verifying correct insurance filing information on behalf of the client and patient
• Verifying receipt of all patient registration data from the client and notifying the client of potential coding problems.
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Follow up on unpaid claims within the standard billing cycle time frame.
• Research and appeal denied claims.
• Meet individual and departmental standards with regard to quality and productivity.
• Ability to handle protected health information in a manner consistent with the Health Insurance Portability and Accountability (HIPAA).
• Check eligibility and benefit verification.
• Review patient bills for accuracy and completeness and obtain any missing information
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid.

Responsibilities and Duties

Able to perform eligibility verification, precertification, through the web or verbally with insurance companies.
Calling insurance companies and obtaining claim status with different payers & documenting it in the system.
Should be able to read superbills and make charge entry in PMS.
Ability to post ERA (Electronica Remittance Advice) & EOB (Explanation of Benefits) from various systems and websites.
Credentialing knowledge would be an added advantage
Denial management should be known.