October 17, 2018
October 25, 2018
The Billing/Coding Specialist performs a variety of functions in the revenue cycle, including, but not limited to, the items listed below:
Duties and Responsibilities
- Follow up on open balances due from insurances and other third party payors that are over 3 weeks old.
- Review charges posted by providers for medical, behavioral health, and dental claims.
- Attend to and answer patient questions regarding balances due such as deductibles, co-insurance, and copayments due from the patient.
- Manage and follow up on payment plans offered to patients with outstanding balances.
- Process, follow up on, and resolve requests for medical records and itemized billings.
- Document in each account any changes in claim status.
- Identify claims that need referrals or additional information for payment.
- Manually post payments from online lockbox, and reconcile payments posted against the amount in the lockbox. Flag and follow up on claim denials.
- Review and reconcile payments that are downloaded from clearinghouse.
- Review and analyze patient account credits and debits and initiate refund request for monies owed.
- Review and analyze account balances when insurances are requesting a refund.
- Follow up on all patient accounts where claim was denied for “patient not eligible at time of service”.
- Follow up with patients when updated insurance information is needed to process claim.
- Maintain regular communications with patients until such time that the accounts are paid in full.
- Attend all meetings of the department and other PrimeCare all-staff meetings.
- Coordinate and submit settlement offers for approval.
- Other duties, as assigned.
Required Skills or Abilities
- Work effectively with a diverse set of professionals and with multiple disciplines.
- Exercise independent judgment and prioritize effectively.
- Analyze, recommend, and implement creative improvements.
- Demonstrated ability to work in a team-based environment.
- Strong interpersonal skills, including the ability to establish strong working relationships and to communicate effectively and in a confidential manner.
- Maintain appropriate professional boundaries with all staff, trainees, and patients at all times.
- Demonstrate respect and sensitivity for cultural diversity, gender differences, and sexual orientation of patients and co-workers.
- Knowledge of ICD-10 and CPT-4 coding as well as basic medical terminology.
- Familiarity with EOBs (explanation of benefits).
- Proficient skills/experience with Microsoft Office products (Outlook, Word, Excel, PowerPoint) and Adobe.
Required Knowledge, Experience, or Licensure/Registration
- High school diploma required. Completion of certified coding program strongly preferred. Bachelor’s degree in business administration, accounting, or finance preferred.
- 3 – 5 years of experience in outpatient/inpatient clinics, Medicaid, Medicare, and commercial insurances and experience in commercial insurance and Medicare/Medicaid follow ups.
- Prior experience in health care organizations and experience with federally qualified health centers strongly preferred.
- Prior experience with Athena strongly beneficial.
- Bilingual in English/Spanish or English/Polish.
Benefits include PTO, Health/Dental/Vision Insurance, Short-term and Long-term Disability Coverage, Life/AD&D, 403(b), paid holidays.