Mambo Seafood Restaurants · 1 day ago
Billing Procedure Claims Specialist
Lawrenceville, GA
Full-time
Hybrid
Mid Level
3+ years expSummit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to their team. The role involves auditing claims, ensuring accurate billing, and addressing inquiries from insurance companies and patients.
Food & Beverages
Responsibilities
Audits and ensure claim information is complete and accurate
Claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management
Ensures accurate and timely billing of HCFA 1500 claims
Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.)
Creates logs for providers of pending medical encounters and or encounters with errors
Work directly with other billing staff and management to meet end of month closing deadlines
Able to work with clearinghouse rejections, print, and mail secondaries
Address inquiries from insurance companies, patients, and providers
Understands CPT, ICD10, HCPCS coding and modifiers
Knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc
Knowledge of ERAs, EOBs
Knowledge of payer specific/LCD guidelines
Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification
Must be proficient with spreadsheets and word processing applications
Qualification
Required
Minimum of 3 years' experience with medical billing or revenue cycle in a medical setting
Experience with Medicare, Medicaid, Commercial insurance plans, Workers' comp, and Personal Injury cases
Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management
Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials
Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required
Excellent computer skills and familiarity with Microsoft Office
Comfortable working in a growing, dynamic organization and able to navigate change
Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment
Preferred
Bachelor's degree preferred
Experience using eClinicalWorks preferred
Experience with high level procedure billing and coding for Pain Management preferred
Benefits
PTO
Health benefits
401k match
Company
Mambo Seafood Restaurants
Mambo Management is the parent company of Mambo Seafood Restaurants.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Nuno Lima
Chief Executive Officer
Tim Leong
CFO
Company data provided by crunchbase