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Medical Billing and Collections

1 month ago

Moore, United States Private Clinical Practice Full time
Job DescriptionJob Description

Overall Responsibility: The billing Coordinator is responsible for managing the day-to-day operations - to coordinate overall functions of billing, maximizing cash flow while improving patient, physician, and other customer relations with the account managers. This position REQUIRES STRONG decision-making leadership and business office skills, including project management, critical thinking, and analytical skills.

Looking for an experienced Medical Billing Specialist. We are a spine practice that thrives on innovation and teamwork.

 

JOB SUMMARY: This position requires a thorough understanding of the billing process for professional providers. Must understand the difference between deductibles, co-insurance, co-pays and OON and how to calculate these amounts. Knowledge of how to read an EOB is necessary. Billing will consist of office visits, DME, X-RAY, UA’s, in-office procedures and Surgeries. Will be responsible for submitting an initial clean claim, follow up, reconsiderations, appeals and working denials/rejections. This position will be responsible for resolving all issues with unpaid insurance claims within a 45 day time period or less. Process and post payments from insurance and patients. Patient statements will be generated and sent monthly. Insure that we have referrals and authorizations. Confirms surgeries scheduled to ensure deductibles, coinsurance and authorizations are obtained/confirmed and patients are approved for surgery or procedure. Performs verification of benefits for EM visit, surgery and DME. Works patient access required by office supervisor.

 

Knowledge of Work Comp and MVA is a plus. Position warrants a professional that requires minimal supervision. Excellent customer service skills.

 

EMR e-clinical

 

Job Specific Requirements

· Manage billing and claims for accuracy, completeness, and compliance with Federal, State, and payer regulations, guidelines and requirements.

· Claims submission daily.

· Generate, analyze and/or managing daily, weekly and monthly reporting, identifying trends impacting charges, denials and collections for process improvements, identifying training needs and recommending process changes.

· Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.

· Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format.

· Ensures that the activities of the professional billing operations are conducted in a manner that is consistent with overall department and organization protocols, policies and procedures.

· Participates in the development and implementation of operating policies and procedures.

· Meet with management team to discuss collection reports, and develop opportunities to reduce denials, research carrier rule changes and distribute the information within the office staff and providers

· Advising Senior Management on a variety of operational, employee, and financial issues.

· Assist as a subject matter expert for all things regarding revenue cycle including workflow and software applications.

· Assist with managing the operations and associates of the billing team, including; claims submissions, payments postings, accounts receivable follow-up and reimbursement management

· Process and complete appeals within 45 days of submission

· Review incoming bulletins from governmental payers, and share with appropriate personnel.

· Retrieve medical records as needed for insurance payers for

· Files liens for MVAs

· Complete follow-up on delinquent accounts by telephone, internet, or correspondence to resolve outstanding balances and to determine payment date.

· Work in tandem with other departments i.e. HIM (Medical Records) to ensure that requests are complete. Post recoups on a daily basis.

· Contractual reviewed and adjusted when necessary.

· Reconciliation of payer remit after electronic posting to patient accounts.

· Process and submit encounters/batches before close of business

· Complete required Confirmation Acceptance Reports, and Transmittal reports on a daily basis.

· Utilize current Age Trial Balance as a resource with a focus on accounts > 45 days in age.

· Follow-up on pending correspondence and other mail received within 72 hours of receipt.

· Enter accurate and thorough comments on each patient account.

· Promote and demonstrate excellent customer service at all times with internal and external customers to include patients, physicians, co-workers and all other customers.

· Communicates effectively and expresses ideas clearly, actively listens and follows appropriate channels of communication.

  • Communicates with Business Office regarding claim processing trends if appropriate

 

Reporting, Analytics & Benchmarking:

Responsible for creating monthly, quarterly and yearly comprehensive reporting by building key performance indicators (KPI) dashboard to demonstrate key performance initiatives as it pertains to revenue cycle management

 

Administrative Responsibility

· Uses time clock accurately and is punctual on a consistent basis.

· Demonstrates a positive attitude in all assigned task and towards others.

· Follows "Call-In" policy. Absences during evaluation period

· Adheres to department dress code. Maintains a professional appearance at all times.

· Perform special duties and projects as assigned.

 

Education: High school diploma or GED

 

Experience: Collections and medical billing experience or a minimum of one-year work experience required. Time management, multi-tasking, organization, scheduling and strong customer service required.

 

PHYSICAL REQUIREMENTS:

Candidate must be able to read and speak English fluently, have cognitive skills for math, reading, computer skills, and communication skills to deal well with the public (customers) as well as peers.

Lifting of 20-30 pounds, potential for exposure to blood and body fluids (minimal).

I understand the medical billing coordinator position, and acknowledge the ability to perform to the standards and performance criteria as described

Company DescriptionPrivate Clinical Practice. Innovative, disciplined, and strong work ethic

Team oriented, always striving for the stars. Optimal performer. Patient care and service is coreCompany DescriptionPrivate Clinical Practice. Innovative, disciplined, and strong work ethic\r
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Team oriented, always striving for the stars. Optimal performer. Patient care and service is core

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