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Professional Credentialed Billing Specialist
2 months ago
ProMedica is seeking a highly skilled Professional Credentialed Billing Specialist to facilitate accurate and timely credentialing, coding, billing, posting, and collection for ProMedica Physicians and supported entities.
Key Responsibilities- Accurately and timely credentialing follow up for all supported providers with hospital privileges, payor/plan credentialing, certifications, and regulations.
- Act as a liaison between providers/office staff and hospitals or payor plans.
- Accurately maintain provider information in credentialing software.
- Accurately review and assign coding for professional services, including diagnosis, modifier, and procedure codes, as well as additional payor requirements.
- Accurately and timely input of billing information into the practice management system for payment.
- Accurately review and update demographic and insurance information in the practice management system.
- Perform a variety of registration, billing, follow up and collection functions for all payers including self-pay.
- Verify insurance benefits, limits, and patient obligations.
- Contact patients for necessary information pertaining to registration, billing, and collection.
- Process financial assistance applications.
- Post payments, adjustments and denials to patient accounts.
- Review accounts for outside collection or legal authorization.
- Work with internal departments to obtain information for external requests including refunds.
- Reviews debits, credits, refunds, bad debt and contractual allowances for accuracy and processes as applicable.
- Knows and follows all billing regulations and corporate compliance plans.
- Provide feedback to management on issues that impede timeliness or quality of billing and work with management to resolve.
- Maintains current payor knowledge for effective claims management and follow up of unresolved claims.
- Routinely reviews workflows for process improvement and efficiencies and provides feedback to management for implementation of changes.
- Independently reviews assigned workloads and completion to ensure goals are being met.
- Acts as a resource for staff.
- Assist management with training new staff.
- Perform other duties as assigned.
- Education: High school diploma or equivalent.
- Skills: Ability to accurately and independently solve problems, excellent communication and interpersonal skills, and commitment to exceptional customer service.
- Previous experience with computers and office equipment, as well as ability to input and retrieve information from a computer, operate a calculator, fax machine and copier.
- Ability to manage large volumes of work, ability to quickly learn and retain information regarding issues that present themselves.
- Experience reading hospital/Physician medical records.
- Detailed understanding of CPT & ICD-9 (10) coding.
- Detailed understanding of Professional charging processes.
- Experience completing hospital and payor credentialing forms.
- At least 3 years' experience in Professional/Physician billing/collection with at least 2 years' experience specific to billing office work.
Must be able to move about office and between workstations and occasionally lift, move, and carry moderately heavy materials.
Pay Range$32,240-$55,120
