Medical Billing Specialist

Chartered by the state of Georgia in 1785, the University of Georgia is the birthplace of public higher education in America and is the state's flagship university (https://www.uga.edu/). The proof is in our more than 240 years of academic and professional achievements and our continual commitment to higher education. UGA is currently ranked among the top 20 public universities in U.S. News & World Report. The University's main campus is located in Athens, approximately 65 miles northeast of Atlanta, with extended campuses in Atlanta, Griffin, Gwinnett, and Tifton. UGA employs approximately 3,100 faculty and more than 7,700 full-time staff. The University's enrollment exceeds 41,000 students including over 31,000 undergraduates and over 10,000 graduate and professional students. Academic programs reside in 19 schools and colleges, including our newly established School of Medicine.

Monday - Friday 8 am - 5 pm

We are unable to offer a work visa sponsorship for this position,. You must be authorized to work in the U.S. to apply.

The University of Georgia is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, genetic information, national origin, race, religion, sex, or veteran status or other protected status. Persons needing accommodations or assistance with the accessibility of materials related to this search are encouraged to contact Central HR ( hrweb@uga.edu).

The University System of Georgia is comprised of our 25 institutions of higher education and learning, as well the System Office. Our USG Statement of Core Values are Integrity, Excellence, Accountability, and Respect. These values serve as the foundation for all that we do as an organization, and each USG community member is responsible for demonstrating and upholding these standards. More details on the USG Statement of Core Values and Code of Conduct are available in USG Board Policy 08.02.18.01.02.

Additionally, USG supports Freedom of Expression as stated in Board Policy 06.05 Freedom of Expression and Academic Freedom.

UHC Minimum:
* Minimum of five (5) years experience in a healthcare environment with direct experience with financial counseling, insurance billing and follow-up. Knowledge of medical terminology related to Current Procedural Terminology ( CPT), Healthcare Common Procedure Coding System ( HCPCS) and International Statistical Classification of Diseases ( ICD-10).

UHC Preferred:
* Certified Professional Coder ( CPC) certification, which includes staying current with AAPC (American Academy of Professional Coders) membership.
* Bachelor's or Associate degree in English, Business Administration or other related field from an accredited college or university preferred.
* Certified Professional Medical Auditor ( CPMA) certification preferred.
* Three (3) years experience in a multispecialty practice or hospital setting.

The Medical Billing Specialist plays a key role within the Business Services Department and reports to the Coding and Compliance Manager. This position is responsible for ensuring accurate and timely preparation, review, correction, and submission of medical, vision, and CAPS claims in accordance with Medicare guidelines, along with processing insurance remittances. The role also includes monitoring outstanding claims, addressing delays and denials, maintaining up-to-date medical terminology knowledge, and delivering customer support by managing phone inquiries, processing payments, and advising students on insurance benefits and account balances.

* Demonstrates strong customer service, verbal communication, and interpersonal skills, along with proficiency in Microsoft Office, basic math, and the ability to manage multiple tasks with accuracy and attention to detail.
* Applies a comprehensive understanding of insurance payers and reimbursement methodologies as they relate to billing processes.
* Maintains proficiency in Electronic Medical Record ( EMR) systems to support accurate documentation and billing activities.
* Communicates effectively and professionally with colleagues and cross-functional departments to resolve coding, billing, and claims issues.
* Possess and/or willing to obtain a Certified Professional Coder ( CPC) certification from a nationally accredited organization.

Ability to see objects closely, as in reading. Must be able to operate all equipment required. Ability to sit for long periods of time (4-8 hours). Must be able to perform fine motor skills.

Be advised a credit check will be required for all positions with financial responsibilities. For additional information about the credit check criteria, visit the UGA Credit Background Check website.

Offers of employment are contingent upon completion of a background investigation including, a criminal background check demonstrating your eligibility for employment with the University of Georgia; confirmation of the credentials and employment history reflected in your application materials (including reference checks) as they relate to the job-based requirements of the position applied for; and, if applicable, a satisfactory credit check. You may also be subject to a pre-employment drug test for positions with high-risk responsibilities, if applicable. Please visit the UGA Background Check website.

Claims Processing:
* Reviews charge tickets and SOAP notes to ensure claims are prepared accurately.
* Submits and processes all electronic claims through our third-party clearinghouse to ensure timely and accurate billing.
* Prepares and distributes HCFA-1500 claim forms via mail for claims that cannot be submitted electronically.
* Reviews clearinghouse reports for rejected claims and implements corrective actions to reduce future denials.
* Responds to billing inquiries via email, fax, instant messaging, and phone in accordance with departmental policies; submits secondary claims with the primary payer's explanation of benefits ( EOB).
* Collaborates with the University of Georgia Athletic Department and Athletic Insurance Coordinator to ensure timely and accurate processing of charges for services rendered at the University Health Center, including medical, pharmacy, dental, and vision services.

Payments and Claims Follow-Up
* Post insurance payments accurately to ensure the account balance is correct.
* Reviews remittances and insurance Explanation of Benefits (EOB's) to verify accurate contractual adjustments and escalate discrepancies to the appropriate Business Services staff.
* Researches, analyzes, and monitors unpaid claims to identify lost revenue related to coding errors, unbilled services, and incorrect reimbursements.
* Monitors aging claims and communicates with insurance carriers regarding claims exceeding 90 days.
* Submits appeals for claims denied due to timely filing and provides documentation supporting timely submission through the EMR system.
* Communicate with patient and/or family member regarding insurance coverage and claim status, including appeal processes when appropriate.
* Corrects claims discrepancies and resubmits claims to ensure proper resolution and reimbursement.
* Maintains and reconciles daily deposit records.

Customer Service Support
* Answers incoming calls courteously and professionally, ensuring high level of customer service.
* Provides a positive first impression to all customers, including students, insurance carrier reps. and departmental liaisons.
* Assists callers by explaining charges within the Practice Management System ( PMS) and addressing related inquiries.
* Utilizes the PMS to effectively support inquiries related to balances, insurance details, diagnoses, billed amounts, adjustments, and payments.
* Reviews notes or other actions taken on accounts to resolve inquiries efficiently and minimize unnecessary call transfers.
* Escalate complex issues to supervisor or other departments, providing relevant account details and documentation.
* Documents all telephone interactions thoroughly by entering detailed notes into the system to ensure continuity of service.

Coding and Compliance Knowledge
*Understands Medicare, Medicaid, Tricare and other government payers as it relates to collections and billing.
*Ensures patient accounts contain accurate Current Procedural Terminology ( CPT), Healthcare Common Procedure Coding System ( HCPCS) and International Statistical Classification of Diseases ( ICD-10) codes are assigned to patient accounts by University Health Center ( UHC) providers.
*Extensively uses the Point N Click (PnC) information system, CPT, HCPCS and ICD coding manuals as well as various supporting resources related to coding and medical science.
*Identifies and assigns appropriate codes for new services.
*Reviews and removes outdated codes from the Fee Schedule to maintain accuracy.
*Communicates coding updates and discrepancies to the Coding and Compliance Manager.