Medical Billing Specialist

Job Description:

Circadia Health is a medical device and data technology company that has developed the world's first FDA cleared contactless remote patient monitoring system. Powered by cutting-edge technology and AI, the system allows for the early detection of medical events such as Congestive Heart Failure, COPD Exacerbations, Pneumonia, Sepsis, UTIs, and Falls.We're monitoring over 20,000+ lives daily and growing rapidly. As we scale our team, Circadia is looking for energetic, personable, and solutions-oriented individuals driven by creating the ultimate customer experience. Prior experience in healthcare is a big plus, but not required.Our mission is to enhance patient outcomes and improve healthcare processes by providing cutting-edge solutions to healthcare providers and patients alike.

Position Overview: As a Medical Billing Specialist at Circadia in this role, you will be responsible for ensuring timely submission of invoices, coordinating with providers and insurance companies, and collaborating effectively with our team. Attention to detail and a strong understanding of medical terminology, insurance procedures, and healthcare laws and regulations regarding medical billing are essential for success in this position.

Key Responsibilities:

Claims Management:

Prepare and submit clean claims to insurance companies electronically or by paper.

Correct and resubmit claims to third-party payers.

Review, investigate, and correct denials, then rebill within 2-3 days of receipt of Explanation of Benefits or Remittance Advice.

Make adjustments or corrections on denied claims due to missing information or changes in patient status.

Perform denial management by identifying, analyzing, and resolving denied claims.

Insurance and Patient Communication:

Contact insurance companies regarding unpaid claims via rebill, appeals, or phone.

Respond to patient inquiries and billing concerns via phone, email, and messaging portals.

Perform follow-up calls and written correspondence to patients and payers as needed.

Financial and Billing Assistance:

Evaluate patient financial status and establish budget payment plans.

Identify and resolve patient billing complaints.

Prepare, review, and send patient statements as needed.

Mail appropriate patient contact letters to resolve outstanding claims.

Collections and Payment Processing:

Perform various collection actions, including contacting patients by phone.

Monitor and reconcile third-party insurance remittance and cash collections.

Scan checks and ensure accurate posting of payments.

Perform collections for unpaid patient balances, including follow-up calls and written correspondence.

Documentation and Software Use:

Utilize Practice Management software to complete assigned AR and Patient tasking.

Maintain records, logs, and other documentation required to track account statuses.

Request documentation from other sources, as appropriate.

Regulatory Compliance and Confidentiality:

Maintain strictest confidentiality and adhere to all HIPAA guidelines/regulations.

Well-versed in collecting and billing for governmental programs, with full knowledge of governmental collection regulations and guidelines.

Administrative Duties:

Accept incoming phone calls for customer inquiries.

Perform other duties as assigned.

**Retrieve mail from Westwood offices on a weekly basis.

Qualifications: 

3+ years Outpatient Medical Billing experience

Experience working with all payers – commercial, government, Medicare, Medicaid.

Knowledge of CMS regulations and requirements regarding billing and coding.

High School or equivalent and graduate from an accredited school or program in Medical Billing and Coding.

Benefits:

Full Single Coverage Health Care Plan (Medical, Dental & Vision)

Retirement Plan Contribution (401k, IRA)

Hybrid Role - Ability to work from home when not onsite / office

Paid Time Off ~1.75 days per month (Vacation, Sick & Public Holidays)

Family Leave (Maternity, Paternity)

Professional Training & Development

Annual Company Retreat