Procedural Billing Specialist I

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Job description

Pay Range :$20-$21/hr

Shift Timings: 9am-5pm M-F

Duties:
Job Summary:

-Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.

-Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances.

-Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations.

-Develop and manages fee schedules and for self-pay patients.

-Processes Worker s Compensation claims and addresses/resolves all discrepancies.

-Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.

-Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.

-Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.

-Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis.

-Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.

-Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.

-Researches unidentified or misdirected payments.

-Works credit balance report to ensure adherence to government regulations/guidelines.

-Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.

-Identifies and resolves credentialing issues for department physicians.

-Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.

-Meets with practice management, leadership and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.

-Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.

-Other identified duties as assigned.

Skills:

Required Skills & Experience:

-Excellent organizational skills.

-Excellent communication and customer service skills.

-Knowledge of medical terminology and anatomy.

-Strong attention to detail and ability to multitask.

-Excellent calculation, verbal and communication skills.

-Strong ability in analysis and research.

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