Medical Billing Specialist

4 weeks ago

Brooklyn, New York, United States The Brookdale Hospital Medical Center Full time
Job Title: Specialist (OBH), Cash Operations

Overview:

The Cash Operations Specialist will play a crucial role in obtaining appropriate reimbursement levels for professional services by analyzing denial and rejection reports and appeals whenever necessary. This individual will work closely with practices, payors, and patients to resolve claims, addressing core issues driving denials or slow payments. Additionally, they will assist in charge capture and charge entry if required.

Responsibilities:

  • Review and clear hold buckets for professional fee claims.
  • Develop expert knowledge of AthenaHealth practice management system.
  • Manage Medicaid pending and workers compensation claims support.
  • Develop relationships with key payor representatives for timely claim adjudication.
  • Develop relationships with practice plan personnel to assist in rectifying registration and coding related denials, and to acquire additional documentation for appeals.
  • Develop relationship with credentialing office to assist in clearing credentialing related bill holds.
  • Maintain a working knowledge of CPT-4 and ICD-9/10-CM coding principles, governmental regulations, protocols, and third-party requirements pertaining to billing and documentation.
  • Answer patient and/or payor questions regarding billed amounts.
  • Provide accurate and concise communication to practices informing them of best practices.
  • Ensure maximum efficiency and reimbursement for properly documented services.
  • Review, modify, and recommend changes to policies and procedures to improve professional fee billing and to maximize reimbursement.
  • Effectively manage A/R, bad debt, credit balance/refunds, and collections.
  • Patient services and mail (sort and distribute).
  • Reconcile all payments (Bank, copayment) and produce financial month-end reports.
  • Track, scan, and upload payments to Athena.
  • Obtain Insurance Web access for all facilities (web portal, set up ERA/EFT, etc.).
  • All other duties as requested.

Qualifications:

  • Associates Degree.
  • OR Successful completion of an AHIMA approved Coding Certificate Program.

Experience:

  • Prior experience using AthenaHealth practice management or similar physician practice management system is required.
  • Minimum three (3) years of professional fee reimbursement experience is required.
  • Emergency Department, Radiology, and Cardiology experience will be considered in lieu of certain other requirements.

Knowledge and Skills:

  • Must possess a thorough working knowledge of ICD-9/10-CM and CPT-4 coding systems as demonstrated by certification through AHIMA.
  • Knowledge of medical terminology, physician reimbursement models, and medical abbreviations is required.
  • Ability to fully utilize BHMC's electronic record systems, equipment, and other healthcare and billing systems, as well as be proficient with Microsoft Windows and Microsoft Office.
  • Familiarity with physician practice management software (AthenHealth, EPIC, etc.) and electronic medical record a plus.
  • Ability to assist in translating physician orders to diagnosis or CPT-4 coding levels.

Licenses, Certifications:

  • Certification and Registration with the American Association of Medical Assistants, preferred.
  • Medical Assistant Certification preferred.

Physical Requirements:

  • Position requires prolonged periods of sitting and use of a computer and screen viewing throughout the working day.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of The Brookdale Hospital Medical Center (BHMC).

BHMC is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability, or handicap, or other characteristics protected by applicable federal, state, or local laws.

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