Medical Billing Specialist

6 days ago

Islamabad, Islamabad, Pakistan PRG Pakistan Full time

**Job Overview**

At PRG Pakistan, we are seeking a skilled Medical Billing Executive to join our team. As a Medical Billing Executive, you will be responsible for managing insurance verifications, processing claims, handling follow-ups with insurance providers and patients, and resolving discrepancies.

The ideal candidate will have a solid understanding of Medicare, Medicaid, and multi-specialty billing. They will also possess excellent communication skills and attention to detail, ensuring timely and accurate billing processes.

  • Key Responsibilities:
  • Verify patient eligibility and benefits by making phone calls and accessing web portals to ensure accurate insurance coverage before proceeding with any treatments or procedures.
  • Prepare, review, and submit claims using billing software, ensuring that both electronic and paper claims are processed correctly. Identify secondary and tertiary insurance carriers and submit claims accordingly to ensure maximum reimbursement.
  • Review insurance payments for accuracy, ensuring they comply with the agreed contract discounts. Post payments accurately into the billing software using EOB/ERA data to maintain precise records.
  • Review patient bills for accuracy, ensuring all charges are correctly applied and complete. Follow up on any missing information from patients or insurance companies, and generate patient statements to collect outstanding balances.
  • Ensure all necessary referrals and pre-authorizations are obtained from insurance companies before proceeding with any procedures or treatments, ensuring no delays in the billing process.
  • Promptly contact insurance companies to resolve issues when discrepancies in payments occur, ensuring timely corrections and preventing delayed payments.
  • Review all accounts to ensure that both insurance and patient follow-up are conducted thoroughly. Regularly follow up on unpaid claims through phone calls to insurance companies and by checking web portals for updates.
  • Conduct research on denied claims, identifying the cause and resolving the issues in a timely manner. Appeal denied claims with appropriate documentation to ensure that reimbursements are maximized.
  • Ensure that billing software is updated to reflect any changes in the fee schedule or insurance contract terms. This guarantees compliance with the most current rates and prevents discrepancies.
  • Maintain and update cash spreadsheets to track payments and outstanding balances. Generate collection reports for internal tracking and to monitor cash flow.
  • Professionally handle and respond to patient or insurance inquiries related to assigned accounts, ensuring clear communication and timely resolutions to any questions or issues.

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