Billing and Coding Specialist
2 weeks ago
The Billing and Coding Specialist is responsible for supporting the department in maximizing revenue and cash flow by validating ICD and CPT codes, performing charge entries, following up on all outstanding A/R, including resolution of denials, and generating effective written appeals to carriers to maximize reimbursement on incorrectly denied claims. The Billing and Coding Specialist handles all correspondence related to an insurance or patient account, contacting carriers, patients, and other facilities as needed to get maximum payment on accounts and identify issues or changes. They utilize training and knowledge to interpret, understand, and apply appropriate coding, apply complex Medicare guidelines to reduce claim denials, and consistently practice established Peak standards and expectations to achieve superior client satisfaction and retention.
Essential Duties and Responsibilities:
- Enter and validate procedures and diagnosis based on documentation obtained from patient records.
- Review clinical documentation and validate ICD/CPT Codes when necessary and applicable.
- Assist with coding audits as necessary/needed.
- Perform accurate analysis of medical records to obtain necessary information for the appropriate sequencing and assignment of ICD-10, CPT, and HCPS codes.
- Validate and verify data entered by reviewing reports for errors and correcting as necessary.
- Collaborate with managers in assigned areas and provide feedback regarding documentation issues or reoccurring errors.
- Ensure timely follow-up of unpaid claims, resolution of denials, and other payer-related correspondence through appropriate research and appeal processes.
- Resolve claim rejections, underpayments, and denials with appropriate payer and initiate collection follow-up of unpaid or denied claims, interpreting remittances to determine appropriate course of action.
- Identify and respond to patterns of denials or billing practices and perform complex account investigation as needed, to achieve resolution.
- Pursue reimbursement from carriers by placing phone calls and recording all contact in an electronic tracking system, ensuring progress is made on outstanding accounts.
- Coordinate third party collections and work toward the successful reduction in outstanding balances for assigned divisions or projects.
- Maintain patient confidentiality according to compliance policies and HIPPAA.
- Respond to inquiries from insurance carriers via telephone, email and/or fax, demonstrating a high level of customer service.
- Review and resolve uncollected accounts and prepare charge corrections and write offs.
- Special projects as assigned.
Required Skills and Abilities:
- Excellent problem-solving skills
- Detail oriented and organized
- Able to multi-task and work quickly, with constantly changing circumstances and priorities
- Ability to establish and maintain effective working relationships with patients, management, employees, and the public.
- Demonstrated ability to read and interpret EOB’s (Explanation of Benefits) and insurance contractual adjustments
- Strong computer skills
- Able to prioritize assignments and work under minimal supervision
- Ability to handle a high volume of work with speed and accuracy
- Proven ability in collections and negotiation
Education and Experience:
- High school diploma or equivalent
- Minimum of 2 years of experience in a fast-paced medical billing environment
- Experience in a health care setting required
- Experience working unpaid claims and denials
- Proficiency in MS Office
- Familiarity with CPT and ICD-10 required; CPC certification preferred
Gastro Care Partners is the national partner for successful regional gastroenterology practices. We believe in the mantra “medicine is local.” Gastro Care Partners provides high-performing regional practices with the resources necessary to thrive in today’s dynamic healthcare landscape while maintaining their practices’ identities.
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