Tasks & Responsibilities:

A medical billing specialist in a mental health outpatient clinic focuses on ensuring accurate and timely billing, submitting claims, following up on denials, and managing patient accounts, all while adhering to mental health-specific billing guidelines.

Here's a more detailed breakdown of their tasks and responsibilities:

Billing and Claims Management:

Claim Submission:

Preparing and submitting accurate claims to insurance companies, ensuring all necessary information is included.

Claim Status Monitoring:

Tracking the status of submitted claims and following up with insurance companies on pending or rejected claims.

Denial Management:

Investigating and appealing denied claims, identifying reasons for denials, and correcting errors to ensure timely reimbursement.

Coding Accuracy:

Ensuring the accurate coding of diagnoses and procedures to align with insurance guidelines and billing requirements.

Pre-Authorization:

Obtaining necessary pre-authorizations from insurance companies for certain services or treatments.

Invoice Preparation:

Creating and sending invoices to patients for outstanding balances or copays.

Payment Processing:

Recording and reconciling payments received from patients and insurance companies.

Electronic Health Record (EHR) Management:

Inputting and managing billing information within the clinic's EHR system.

Patient and Insurance Communication:

Patient Communication:

Communicating with patients regarding billing questions, outstanding balances, and payment arrangements.

Insurance Communication:

Contacting insurance companies to verify coverage, obtain pre-authorizations, and resolve billing issues.

Data Accuracy:

Ensuring the accuracy and completeness of patient demographic and insurance information.

Client Invoices:

Creating and sending invoices to clients.

Other Responsibilities:

Compliance: Staying up-to-date with current billing regulations and guidelines.

Reconciliation: Reconciling payments received with claims submitted.

Reporting: Generating reports on billing performance and trends.

Training: Assisting with training new staff on billing procedures and software.

Problem-Solving: Identifying and resolving billing-related problems and issues.

Required Skills/Abilities

For a Medical Billing Specialist in a mental health outpatient clinic, required skills include strong organizational and analytical abilities, attention to detail, knowledge of billing software and insurance policies, excellent communication, and the ability to handle confidential information.

Here's a more detailed breakdown of the required skills and abilities:

Technical Skills:

Billing Software Proficiency:

Experience with electronic medical records (EMR) systems and billing software is crucial.

Coding Knowledge:

Familiarity with ICD-10 and CPT codes, as well as mental health-specific codes, is essential.

Insurance Knowledge:

Understanding of various insurance plans, including in-network and out-of-network benefits, and local coverage determinations is necessary.

HIPAA Compliance:

Thorough knowledge of HIPAA regulations and patient confidentiality protocols is a must.

Microsoft Office Suite:

Proficiency in programs like Word, Excel, and Outlook is expected.

Soft Skills:

Attention to Detail: Accuracy in data entry and claim processing is critical.

Organizational Skills: Ability to manage multiple tasks and prioritize workload effectively.

Communication Skills: Strong verbal and written communication skills are needed to interact with patients, providers, and insurance companies.

Customer Service Skills: Ability to handle patient inquiries and resolve billing issues professionally.

Problem-Solving Skills: Ability to identify and resolve billing problems and denials.

Analytical Skills: Ability to review claims data and identify trends or errors.

Time Management Skills: Ability to meet deadlines and manage workload effectively.

Adaptability: Ability to adjust to changes in billing procedures and insurance policies.

Ethical Conduct: Ability to maintain confidentiality and act with integrity in all interactions.

Multitasking: Ability to handle multiple tasks and prioritize workload effectively.

Collaboration: Ability to work effectively with other healthcare professionals.

$ - 👉Pay determined by experience

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