Amen Clinics are outpatient health care clinics that have been providing mental wellness strategies to patients of all ages since 1989. We offer patient-first experiences and customized solutions to an array of behavioral and psychiatric conditions. Amen Clinics employs an array of healthcare professionals across our nationwide locations, including: psychiatrists, integrative physicians, nutritionists, therapists and wellness coaches. These practitioners have diverse educational backgrounds and specialties and are skilled at treating patients in the least harmful, most effective means possible. We use all the tools available to us to help make brain health happen. We believe that a better brain always leads to a better life and that achieving our mission will help to prevent and alleviate suffering, not only for individuals, but also for generations of individuals.
The Medical Billing Insurance Specialist prepares and submits insurance claims to various insurance companies. They are responsible for maintaining records of medical billing and claims, denials, settlements, and medical insurance. They respond to questions from patients, clerical staff, and insurance companies, as well as identify and resolve patient billing complaints. The Medical Billing Insurance Specialist understands coding for diagnosis, procedures and billing, verifying diagnoses and procedures with the physicians to avoid discrepancies.
• Accurately completes claim forms by contacting patients and various points of contact.
• Validates eligibility, benefits, deductibles and produces accurate documentation.
• Reports to billing supervisors and managers in matters of medical bills.
• Provide and ROI and insurance inquiry and reimbursement report to management.
• Responds to Billing Requisitions and Inquiries in a timely fashion; reconciles monthly reports.
• Advocates on the behalf of the patient, clinical provider and insurance provider to achieve the anticipated goals and outcomes set by the treating physician.
• Verifies insurance benefits and secures authorizations for diagnostic and ancillary services.
• Enters all EOB and RAD information received into our EMR.
• Reviews physician referrals for completeness and accuracy ensuring the referral includes patient name, diagnosis, type of service, frequency and duration, physician signature, date and authorization number is required. Faxes referral to referring physician if information is incomplete.
• Verifies insurance benefits and secures authorizations for all specialty services.
• Documents patient contact and progress with obtaining insurance authorizations.
• Documents the referral and authorization process, insurance benefits and coverage to patients.
• Assists in the development and implementation of operational improvements to increase efficiencies and effectiveness in conjunction with attendance at Managed Care forums as assigned.
• Facilitates coordination and administrative functions for outpatient psychiatric and integrative medicine programs and services.
• Other duties as assigned.
• High School Diploma; Associate’s/Bachelor’s degree or equivalent experience preferred
• 3+ years medical billing experience in healthcare setting: hospital, medical office, outpatient clinic, etc.
• Proficient knowledge of medical terminology
• Proficient knowledge of medical billing
• Knowledge of ICD (International Classification of Disease) and CPT (Current Procedural Terminology) codes
• Demonstrates knowledge and proficiency of the patient billing system to include: Guarantor Information, Benefit Information, Insurance Information, Insurance Priority, Episode of Care Information, Referral Received, On-line Notes, Adding insurance, etc.
• Must be responsible, highly organized, and have an eye for detail
• Must have the ability to interpret RADs, EOBs and claim appeals
• Must have the ability to operate a computer and basic office equipment
• Must have the ability to read and understand oral and written instructions
• Must have the ability to establish and maintain effective working relationship with patients, employees, and the public
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Frequent sitting for long periods of time
• Frequent typing and viewing of computer screen
• Frequent use of hand and fingers with machines, such as computer, copier, fax machine, scanner and telephone
• Frequent hearing, listening and speaking by telephone and in person
• Occasionally required to stand, walk, reach with hands and arms, stoop or bend
• Occasionally required to lift objects up to 15lbs. with ability to lift multiple times per day
The work environment described here are representative of those that an employee encounters white performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Work indoors in temperature-controlled environment
• The noise level is moderate to high in a call center environment