Senior Clinic Billing Specialist
Responsible for reviewing clinic/outpatient/inpatient documentation, auditing or assigning appropriate codes and modifiers according to the latest editions of CPT, HCPCS, and ICD10 to complete charge posting process. Required to follow the latest CCI Edits and insurance specific policies to ensure prompt turnaround on claims. Responsible for processing and filing insurance claims and assists patients in completing insurance forms, also responsible for working insurance denials, rejections, along with insurance follow up and reconciliation. Immediately communicates any identified problems that may affect cash flow to the Billing Supervisor. Responsible for assessing the billing cycles and anticipating problem areas for early intervention.
KEY RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO:
- Assigning or validation of CPT/ICD-10 Codes on the claim, charge entry (including but not limited to provider office visits, procedures and verification of lab codes for satellite clinics), claims submission, payment posting, and accounts receivable follow-up. Will work with other staff to follow up on accounts until zero balance.
- Serves as a practice expert and go to person for all documentation and billing processes including RHC billing requirements, appropriate use of modifiers, specialty provider coding, etc. and communicates possible documentation or modification of codes to maximize reimbursement as allowed by coding and payer guidelines.
- Analyzes claims for accuracy and completeness; submits claims to proper insurance entities following their specific billing regulations and troubleshoots issues.
- Assists patients in completing insurance forms and answering patient questions concerning the billing process as needed
- Mentors and assists in training
- Communicates with Clinic Managers and Clinic Administration regarding registration information issues and provides education as appropriate. Provides feedback to providers, nursing staff and any other appropriate staff on issues found in billing and charge entry process.
- Participates in policy and procedure implementation and audits current procedures to monitor and improve efficiency of billing and collections operations.
- Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements including working knowledge of all health information management issues such as HIPAA, .
- Analyzes trends impacting charges, coding, collection, and accounts receivable and takes appropriate action to alert Clinic Management and Administration.
- Keeps up to date with carrier rule changes and distributes the information within the practice.
- Understands and remains updated with current coding and billing regulations and compliance requirements.
- Participates in continuous learning and stays abreast of changes in reimbursement and communicates these changes to Billing Supervisor and Clinic Administration.
- Performs other miscellaneous job-related duties as assigned.
EDUCATION / CERTIFICATION / EXPEREINCE REQUIREMENTS:
- Education: Associates Degree or higher is preferred, but will consider relevant experience
- Certified Coder through AAPC or AHIMA is required, Specialty Certification is also preferred
- Prior experience working in an electronic medical records and practice management system is a must
- MINIMUM of 5 years of experience in medical insurance/healthcare billing and collections in a medical practice or health system with a deep understanding of medical billing rules and regulations
- A combination of education and experience will be considered
Open until filled