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CPC Certified Billing

4 months ago

Englewood, United States Progressive Spine & Orthopaedics, LLC Full time
Job DescriptionJob Description

CPC Certified Billing & Coding Specialist

NOTE: Must be CPC Certified by AAPC

SUMMARY: Requires knowledge of ICD-10 coding, accurate typing skills, computer knowledge, prior utilization of an Electronic Medical Record system, knowledge of medical terminology, and the ability to communicate effectively with physicians, co-workers, insurance plan representatives and attorneys.

DUTIES AND RESPONSIBILITIES:

  • Identify billing errors for corrections and resubmit claims to insurance carriers.
  • Follow up on payment errors, low reimbursement, and denials.
  • Compile, code, and submit patient insurance claims to insurance companies as well as follow up on all claims from charge entry through resolution.
  • Review insurance EOB’s and initiate appeals as necessary.
  • Respond and appeal to medical necessity denials.
  • Updating system errors, noting system, researching insurance guidelines.
  • Follow protocol to determine best course of action to follow up on open receivables.
  • Research root issue of denial. Apply knowledge of payer policies to pursue proper course of appeal or follow up to obtain payment.
  • Review account history for continuous follow up.
  • Contact insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals.
  • Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review.
  • Escalate issues and problems to supervisor as appropriate.
  • Identify trends or patters of persistent problems.
  • Perform charge corrections based on payer and institutional policies.
  • Negotiate out-of-network reimbursement, based on determined criteria for max reimbursement.
  • Perform other related duties as assigned by management.

QUALIFICATIONS:

  • High school diploma or equivalent.
  • Certified Professional Coder Certification (CPC) from AAPC required.
  • Three to five years experience with ICD-10, insurance collections and processing out-of-network claims.
  • Excellent written and oral communication skills.
  • 10-key by touch; keyboarding speed of at least 50 wpm.
  • Knowledge of medical billing terminology.
  • Ability to perform diversified clerical functions and basic accounting procedures.
  • Ability to effectively communicate with people at all levels and from various backgrounds.
  • Commitment to excellence and high standards.
  • Strong organizational, problem-solving, and analytical skills.
  • Ability to manage priorities and workflow.
  • Acute attention to detail.
  • Ability to work independently and as a member of various teams and committees.
  • Proven ability to handle multiple projects and meet deadlines
  • Bilingual skills a plus.

BENEFITS:

  • Competitive salary and benefits package
  • Health, dental, and vision insurance
  • Retirement Plan
  • Employee Assistance Program
  • Paid Time Off
  • Opportunities for professional development and growth
  • Collaborative and supportive work environment

Progressive Spine & Orthopaedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.