Procedural Billing Specialist I

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Job description

Duties:

Job Summary:

-Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.

-Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances.

-Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations.

-Develop and manages fee schedules and for self-pay patients.

-Processes Worker s Compensation claims and addresses/resolves all discrepancies.

-Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.

-Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.

-Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.

-Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis.

-Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.

-Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.

-Researches unidentified or misdirected payments.

-Works credit balance report to ensure adherence to government regulations/guidelines.

-Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.

-Identifies and resolves credentialing issues for department physicians.

-Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.

-Meets with practice management, leadership and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.

-Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.

-Other identified duties as assigned.

Education:

Required Education:

-N/A

Preferred Education:

-Associate s degree preferred.

Required Certifications & Licensure:

-N/A

Preferred Certifications & Licensure:

-N/A

Languages:

English( Speak, Read, Write )

Skills:

Required Skills & Experience:

-Excellent organizational skills.

-Excellent communication and customer service skills.

-Knowledge of medical terminology and anatomy.

-Strong attention to detail and ability to multitask.

-Excellent calculation, verbal and communication skills.

-Strong ability in analysis and research.

Preferred Skills & Experience:

-N/A

City: New York

Schedule:

Start Date: 11/18/2024

End Date: 02/15/2025

Schedule Notes: 9am-5pm M-F Urology coding experience

Hours Per Week: 37.50

Hours Per Day: 7.50

Days Per Week: 5.00

Skills:

Required

ORGANIZATIONAL SKILLS

CLAIMS

BILLING

PCS

RETAIL SALES

Additional

CPT

CREDIT TASKS

PAYMENTS

ACCURATE DATA ENTRY

ICD

STAFF TRAINING

MENTORS

CREDIT ISSUES

CREDIT SCORES

CODING

OUTPATIENT

CUSTOMER SERVICE ORIENTED

IDX

SETTLEMENTS

CASH FLOW

OFFICE MEDICAL

Languages:
English( Speak, Read, Write )

Start Date:
11/18/2024
Hours Per Week:
37.50

Est. End Date:
02/15/2025
Hours Per Day:
7.50

Schedule Notes:
9am-5pm M-F Urology coding experience
Days Per Week:
5.00

Department:
UROLOGY BILLING ACCOUNT B : (phone number removed)XXXX

MSM

Cloud Department:

Dept / Floor:
6th floor

Shift Hours:
9am-5pm M-F
Contract Type:
Local

Union Position?:
No
Compliance Analyst:

Initial Start Date:

On-Call Required?:
No

Min. Pay Rate:

Max. Pay Rate:

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