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Billing Specialist (Medical)

DEPARTMENT: Billing & Reimbursement

The Opportunity:

Helomics is an Integrated Clinical Contract Research Organization located in the Lawrenceville neighborhood of Pittsburgh, PA. Helomics mission is to improve the standard of care for cancer patients through innovative research and development partnerships with pharmaceutical, diagnostic, biotechnology, and academic organizations, leading to better and more personalized treatments and diagnostic technologies for human disease. Helomics’ CLIA-certified lab provides clinical testing that assists oncologists and surgeons in individualizing patient treatment decisions.

 

Helomics is seeking a professional for the Medical Billing (Medicare & Commercial) & Reimbursement.  This is a fast-paced, continual changing environment and this individual needs to be both independently as well as in a team player to navigate multiple internal and external sources.

Duties & Responsibilities:

  • Manage the Medicare and Commercial process for billing and appeals.

  • Data entry on processing payments

  • Manage and coordinate all activities with HealthRecon Connect to include:

  1. Research payer medical policies, appeals rights, filing & appeal deadlines etc.

  2. First follow up claims

  3. Denial Resolution

  4. 1st Level of Appeals

  5. Mass appeals

  6. Filing secondary & tertiary claims as required

  7. Patient billing

  8. Identification and escalation of absolute AR to client

  9. Weekly and monthly progress reports

  10. other

  • Coordinate and manage all external and internal activities with Xfin.

  • Work with payors on reviewing and resolving remittance errors and claim rejections

  • Address billing related calls from patients and physicians within a timely manner

  • Claim and appeal submissions via calls and portal lookups

  • Research changes and updates to insurance plan-specific claim and appeal processes and requirements

  • Establish ongoing contacts within the insurance plans

  • Knowledge and understanding of Healthcare industry

  • Additional duties to be assigned, as needed

 

Qualifications:

Education:

  • Bachelors Preferred but not required

  • Associates Healthcare, Business Administration or related discipline (Required)

 

Preferred Experience:

  • 2-3 years Medical Billing Experience, Preferred

  • 1-2 years in the Healthcare Industry, Required

  • Experience with Billing Guidelines related to proprietary laboratory services using unlisted, miscellaneous CPT codes

  • Basic Medical Terminology

 

Required Skills:          

  • Must be able to adjust to an ever-changing, work environment and apply time management techniques

  • Must communicate clearly and professionally with internal team and external clients

  • Strong analytical skills; ability to gather and analyze information to produce alternative solutions and positive results

  • Listens and follows directions

  • Reading comprehension

  • Exhibits sound and accurate judgment

  • Proper phone etiquette

  • Demonstrate superior customer service

  • Ability to work independently or in a team setting

  • Attention to detail and organization

  • Proficiency with Microsoft Office, as well as basic computer functions

 

If you  meet the requirements and are seeking a dynamic, challenging atmosphere, with the opportunity to make a difference to help oncologists and their patients, email your resume to Resumes@Helomics.com with the words “Billing Specialist” in the subject of the email.