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Certified Coder/Biller
4 months ago
ONLY CANDIDATES WITH DERMATOLOGY EXPERIENCE SHOULD APPLY
Overview: The Certified Coder/Biller is tasked with managing all aspects of revenue cycle operations, specifically within a dermatology setting. This includes coding, billing, collections, denial management, and financial reporting. Key responsibilities involve overseeing efficient processing of claims, denials, and appeals, as well as resolving billing-related issues. The Certified Coder/Biller will be updated on coding/billing and revenue trends, providing coding education to clinical and billing staff.
Responsibilities:
- Oversee the complete revenue cycle, including billing, coding, collections, and denial management.
- Look for trends and respond to practices and staff in real time.
- Communicate efficiently with billers, providers, front office staff, and practice managers.
- Be able to communicate with a high level of professionalism to provide updates, challenges, and successes of the most recent updates in billing.
- Supervise, develop, and mentor all revenue department staff, including billers and coders.
- Provide updated education on coding trends to clinical, billing, and coding staff.
- Develop, evaluate, implement, and revise policies and procedures related to billing, coding, reimbursement activities, and improvement strategies.
- Run and manage billing compliance program.
- Reconcile all receivables and revenue reports, working closely with the finance department to develop monthly financial statements.
- Manage and update the charge master based on the current CMS fee schedule and negotiated contracts.
- Conduct monthly analyses of Medicare, Medicaid, and third-party payers.
- Review and resolve high level issues related to claim generation and rejected/denied billings and look for trends.
- Stay informed about reimbursement billing procedures of third-party and private insurance payers and government regulations.
- Maintain appropriate internal controls over accounts receivable and the RCM process.
- Oversee the accounts sent for collection and reimbursements from insurance companies and other third-party payers.
- Review, monitor, and evaluate third-party reimbursement, credentialing, researching variances.
- Participate in the development of coding and billing strategies, evaluating processes relative to the revenue cycle, and making recommendations while ensuring compliance with relevant rules and regulations, including HIPAA, Medicaid, Medicare, and specific third-party payers.
- Perform other duties as assigned.
Qualifications:
- Experience: At least five years of medical billing experience in dermatology or an equivalent combination of education and experience, with a preference for medical office experience.
- Knowledge: Comprehensive understanding of third-party payer requirements, including federal, state, and private healthcare plans, as well as the authorization process. Proven experience with dermatology billing, and a solid knowledge of basic insurance policies, procedures, and reimbursement practices with Medicare coding.
- Skills: Demonstrated experience in developing and executing processes. Excellent attention to detail and accuracy. Exceptional communication and interpersonal skills, with the ability to interact professionally with patients, physicians, insurance companies, and colleagues, both verbally and in writing. Maintain high-level organizational skills and ability to document for internal and external use. Strong skillset required in relationship building and problem-solving.
- Education: High school diploma or equivalent. Certifications in:
- CPB – Professional Biller
- CPC – Professional Coder
- CPMA – Medical Auditor
Critical Skills:
1. Customer service
2. Excellent communication and interpersonal skills
3. Multi-tasking
4. Time management
5. Organization and attention to detail
6. Ability to work under pressure.
7. Calming manner
8. Discretion while maintaining patient confidentiality.
9. Problem-solving skills
10. Knowledge of technical and mechanical equipment
11. Able to escalate or resolve issues as necessary – communicate immediately with your supervisor regarding issues that you cannot resolve or situations that affect your ability to perform your job duties.
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