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Billing Specialist

Company: Colorado Sleep Institute
Location: Longmont
Posted on: June 6, 2021

Job Description:

JOB TITLE: Billing Specialist


This medical billing specialist position is a mid-level position responsible for the preparation and submission of medical claims and working first level insurance denials in compliance with Medicare and commercial insurance regulations.


Core duties and responsibilities include the following. Other duties may be assigned.

Knowledge of Medicare NCD/LCD policy requirements relating to products and services billed by our company
Knowledge of commercial insurance policy requirements relating to products and services billed by our company
Knowledge of Medical Necessity requirements relating to products and services billed by our company
Understanding of Prior-authorization and Pre-determination process
Understanding of medical benefits
Scan DME delivery tickets/charges into Athena
Medical Charge entry and claim submission
  • Confirm Medical Policy and Necessity have been met prior to submitting claims
  • Correct any DT errors and document on spreadsheet prior to charge entry
  • Enter charges in accordance with service or product provided
  • Submit appropriate claims to the insurance carrier such as:
    • DME Claims; Purchase claims
      • CPAP, bilevel, ASV
      • Oral Appliance office visits, pano, OA
    • Recurring DME monthly rentals, months 1-4
  • Confirm that claim was successfully submitted
Insurance Claim Denials/Holds
  • Work Insurance claims in hold status or requests for additional information, if necessary
  • Work first level appeals on denied claims
  • Work A/R as assigned
  • Remittance dashboard
  • Insurance refunds
Unpostables Dashboard
Enrollment Dashboard
Prepayment log report
AR reports as assigned
Financial Decision Making
  • Speak with customers regarding their bills and DME compliance questions
  • Speak with staff regarding financial, billing, and compliance questions
  • Set-up financial payment arrangements for patients
Collect patient payments over the phone
Work Athena Cases daily

Keywords: Colorado Sleep Institute, Longmont , Billing Specialist, Other , Longmont, Colorado

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