Medical Office Administrative Specialist

Purpose: Assist the Practice in areas of business operations pertaining to a medical practice. This is a hybrid role assisting the practice in administrative functions organizing internal business operations, office effectiveness as it pertains to revenue cycle. Works with the billing department and assist in credentialling activities, processing application for physician privileges and additional claim processing duties. Duties include reviewing insurances, receiving payment, and posting amount to patient account, and keeping records of collection and status of accounts

Job Duties and Responsibilities:

• Responds to any inquiries from other healthcare organizations regarding privileging issues
• Collects and processes verification and accreditation information including education, training, experience, licensure content, and DEA certification
• Assist in the preparation of the credentialing files and applications, checking for full completeness and accuracy
• Ability to differentiate the difference between in and out of network insurance groups
• Resolves insurance discrepancies and short payments
• Contact and inquire with insurance companies for collection
• Identify issues and provide suggestions for resolution.
• Review the account information and necessary system applications to determine the next appropriate work activity
• Accurately and thoroughly documents the pertinent collection activity performed
• Performs appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission
• Maintains electronic application inventory, complete reports, and resolve high priority functions
• Documents in detail problem/action/ and follow up with insurance companies until resolved
• Possess working knowledge of Explanation of Benefits (EOB’s)
• Assists in the Verification of Refund Requests and Medical Records requests
• Initiate and resolve Appeals for many different insurance payers
• Respond timely to emails and telephone messages as appropriate
• Communicate issues to management, including payer, system, or escalated account issues
• Performs miscellaneous administrative duties, such as answering phones, sorting, and filing correspondence, ordering supplies, auditing files, and preparing reports
• Follows applicable policies and procedures and takes precautions to establish a safe work environment
• Maintains strict patient protocols in accordance with practice policies/ HIPAA requirements
• Maintains a high level of professionalism with patients and works to establish a positive rapport
• Perform additional duties as assigned

Requirements:

• Education: High School Diploma or equivalent required; College degree preferred
• Experience: Minimum of 5 years working in a medical practice administration and combination of working A/R, revenue management
  • Knowledge of medical codes, medical terminology
• Comfortable using a computer;
  • Proficient in Office Management Software, MS Office or similar required
  • Proficient working in Practice management – EMR, required; Compulink and plus
• Language: Ability to read, write, and communicate in English; Bilingual in Spanish, a plus
• License/Certification: None
• Work is performed in an office setting at a desk and computer. Must be able to sit for up to 8 hours, frequently reach with hands and arms, and repeat the same movements

Organizational Skills: Candidate must be detailed oriented, have good analytical and exceptional organization skills.

Problem-Solving Skills: Candidate must possess abilities to problem solve, prioritize, and follow-through completely with assigned tasks. Candidate must possess analytical skills to examine billing information for accuracy and completeness. Candidate must have the ability to work in a fast-paced environment.

Software Experience: Competency in Practice Management systems, Clearinghouse systems, and demonstrated accuracy in claim processing. Candidate must also be competent in Medicare and online credentialling portals.

Communication: This position may be responsible for autonomously communicating with Doctor’s, patients, and staff. Candidate must demonstrate ability to professionally and independently communicate appropriately (both verbally and in writing).

Physical Requirements:

• The Administrative Specialist is frequently required to operate a computer and file and retrieve written and digital documents. The physical demands include, but are not limited to, standing, sitting up to 8- hours a day, walking, lifting, carrying, reaching, handling, kneeling, crouching, and bending.