• Responsible for reviewing and correcting clinical billing with proper CPT/ICD-10/HCPCS codes
• Knowledge of commercial, government & managed care payer reimbursement
• Responsible for removing/working each edit and making changes to billing to ensure the claims are released to the intermediary
• Must ensure front office has entered the insurance accurately and confirm verification was completed.
• Responsible for verifying and pre-surgical collections on cases prior to surgery
• Must bill provider’s surgery cases timely and accurately
• Must coordinate with patient and provider staff if a patient should need to make arrangements for pre-surgical payments
• Read and understand the provider operative report to ensure accurate billing/coding and make recommendation when discrepancies are identified
• Responsible for working claims dashboard on a daily basis in order to reduce denials and unnecessary front end scrubs
• Must work through the provider commercial and patient accounts receivable each month
• Must work through provider collections work list in order to identify and place appropriate accounts with third party collections
• Responsible for filing successful appeals within timely filing limits per insurance carrier(s)
• Responsible for answering patient phone calls and face-to-face patient interaction
• Make reasonable payment arrangements with patients who have displayed a hardship based on statistical values
• Coding certification is a plus

Desired experience:

• Familiar with EOBs, Coding, and experience in EHR systems: 2 years

• High school or equivalent

Required license or certification:

• Certified in Coding

Details